THE CHOLERA: 

A FAMILIAR TREATISE 

ON ITS 

HISTORY, CAUSES, SYMPTOMS AND TREATMENT, 

WITH 

THE MOST EFFECTIVE REMEDIES, 



PROPER MODE OF THEIR ADMINISTRATION, WITHOUT THE 
AID OF A PHYSICIAN, 

THE WHOLE IN LANGUAGE FREE FROM MEDICAL TEEMS, 

ESPECIALLY ADAPTED 

FOR THE USE OF THE PUBLIC GENERALLY, 

ALSO CONTAINING A 



By G. T. Collins, M. D, 



NEW Y O RK : 

FIRST NATIONAL MANUFACTURING AND PUBLISHING CO. 

CINCINNATI: 

J. R. HAWLEY & COMPANY. 

1866. 



Entered according to Act of Congress, in the year 1366, by 

J. E. HAWLEY & COMPANY, 

In the Clerk's Office of the District Court of the United States, for the 
Southern District of Ohio. 



STEREOTYPED AT THE 
FRANKLIN TYPE FOUNDRY, 
CINCINNATI, 0. 



INDEX. 



PART I. 

INTRODUCTION. PAGB 

Cholera anticipated 3 

Object of this treatise 4 

Cholera of 1849-1850 4-5 

Authors referred to ~. ^.~....~.. ...... 7 

PART II. 

HISTORY OF EPIDEMICS. 

Causes of epidemics unknown „. 9 

Medical science of the middle ages 10 

Pestilence A. D. 168, and A. D. 589 , 10 

Religious processions to suppress the plague , 10 

Pestilence of the 14th Century 11 

Atmospheric convulsions 11 

Floods and earthquakes in China, A. D. 1333 12 

Black Death, A D. 1347 12 

in Cypress 12 

Track of the plague 13 

Plague in France 13 

" Italy 13 

" Sardinia 13 

Germany 14 

" Poland 14 

" Sweden 14 

" England 14 

Norway 14 

" Russia 14 

Horrors of the Black Death 14 

Suddenness of the attack 14 

Description of the plague 15 

Fatality among animals 15 

Propagation of the plague 15 

Modified form of the plague 16 

Oriental plague 16 

(0 



11 INDEX. 

PAOE 

Oriental plague identical with cholera 16 

Mortality of the Black Death 16 

Ignorance of the people 17 

India depopulated 17 

Fatality in China 17 

Deaths in principal cities of Europe , 18 

Disposal of the dead 19 

Decline of the plague 16 

Pope Clement VI orders a jubilee 19 

Italy depopulated anew 19 

Plague in Ireland and Greenland 19 

Wealth given to the priests 20 

Universal fear 20 

The Flagellants 21 

Self-imposed penance 22 

Persecutions of the Jews 23 

Jews accused of poisoning the air 23 

" burned to death, A. D. 1348 24 

" protected in Poland and Lithurnia 25 

Cholera attributed to poison, A. D. 1865 25 

Leprosy 27 

" origin of. 27 

" victims of, banished 27 

Parisian Doctors 28 

" " reports of. 28 

" " opinions of the cause of pestilence 29 

'* " means of prevention advised 30 

Grand Phenomenon 31 

Remarkable fertility of women 31 

Imagination a cause of disease 32 

Influence of fear and the passions 32 

Dancing Mania 32 

" " the victims 33 

" " demoralizing effect of. 34 

St. Vitus's Dance 34 

M " cured by music 34 

St. John's Dance , 35 

" " originating in festivals of St. John's Day... 35 

Decline of Dancing Mania. 35 



INDEX. Ill 

PAGE 

Remedies for dancing mania 36 

Tarantism 37 

identical with. St. Vitus's Dance .' 38 

PART III. 

HISTORY OP EPIDEMIC CHOLERA. 

Cholera on the banks of the Ganges, 1817 40 

" Bontius' account of, 1629 40 

" confined to the Hindoos till 1774 41 

11 derivation of the term 41 

Cholera in India 42 

Climate and country 42 

Cholera in Madras 43 

" fatality of, among Europeans 43 

" " in the English fleet 44 

Cholera in Bengal 44 

" first appearance of, 1781 44 

" havoc of, among British troops 44 

The Ganges 45 

Sacred bathing places 45 

Cholera among the pilgrims 45 

Cholera from 1817 46 

" its course up to 1832 46-47 

" first appearance in America 47 

" " " New York 47 

" " " Philadelphia 48 

" 1849-1850 48 

PART IV. 

CAUSE OP CHOLERA. 

Moral and social conditions 50 

Atmospheric causes 51 

Local " 52 

Report of Egyptian government 53 

Uncleanly habits of Mohammedan pilgrims 53 

" " the seed plot-of cholera 54 

The Turkish government 55 

Scenes in Constantinople, 1865 55-56 

Contagion 57 



IV INDEX. 

PAGE 

Cholera in St. Louis, 1849-1850 58 

" non-contagious 59-61 

Electricity 61 

" as an exciting cause , 62 

Animalcular Theory 62 

Choleraic poison acting on the nerves 63 

" " " " blood 63 

PART V. 

SYMPTOMS OF CHOLERA. 

Night most usual time for attack 67 

Generpl symptoms 67-72 

Especial Features of Cholera 72 

Purging 73 

Vomiting 74 

" bilious matter 74 

Internal Heat and Thirst 75 

Spasms 75 

Collapse 76 

Cessation of the pulse 77 

The Skin 77 

" leaden color of. 77 

The Countenance 78 

Breathing 79 

Coolness of the breath 79 

Restlessness 79 

The Voice 80 

The Tongue 80 

The Urine 80 

The Blood 81 

The Senses 82 

LlSTLESSNESS 83 

Termination of Cholera 83 

Recovery 84 

Death 86 

PART VI. 

REMEDIES TRIED. 

Bleeding 88 

Calomel............. .*...*».-»-.-*••»«•»*»-.-»•*««•.-.*..-...« 89 



INDEX. V 

PAGE 

Opiates 89 

Camphor 90 

Internal stimulants 90 

11 " brandy 90 

External stimulants 91 

Heat 91 

Ice 91 

Emetics 92 

" to be used with caution 92 

Purgatives 92 

Injections 93 

Cupping and Bleeding 94 

Transfusion 94 

" illustrative cases 95-96 

A multitude of remedies 96 

Nostrums and nostrum-venders 97 

PART VII. 

TREATMENT. 

What should be done 99 

Premonitory Symptoms 100 

Looseness of the Bowels 100 

Remedies 101 

" for slight diarrhea 101 

11 for obstinate diarrhea 102 

rice-water evacuations 103 

" calomel, valuable 104 

" chloroform mixture 104 

" vomiting 105 

emetics, when to be used 105 

" sudden diarrhea and vomiting 107 

Diet in convalescence 108 

Nausea without purging 109 

Remedies for spasms 109 

" for delirium 109 

for cold extremities 110 

" for cold perspiration 110 

Hot lard 110 

Stimulating ointments Ill 



VI INDEX. 

PAGE 

Convalescence Ill 

Inflammatory symptoms Ill 

Remarks 112-116 

Quacks arid their mixtures * 113 

Opium injurious 114 

Dr. Roe's ointment 117 

Dr. Rhinelander's ointment 117 

Acetate of lead 118 

Dr. Warner's treatment 118 

Asafetida 118 

Be prepared 119 

What to have on hand 120-122 

To take castor-oil 122 

Measures 122 

Doses for children 122 

Alcoholic liquors and tobacco 123 

Diet 123-125 

PART VIII. 

MEASURES FOR PREVENTION. 

Strict attention to diet necessary 126 

Gluttony and debauchery 127 

Caution as to the use of purgatives 128 

" " " fruits and vegetables 128 

Intemperance 128 

Evil effects of intemperance 129 

Rules for Individuals 129-132 

In and about tour Houses 132-134 

Food for the Sick 134-136 

Public Means of Prevention 136 

The cholera in Boston and St. Louis in 1849-1850 138-139 

" " Baltimore 1832 139 

Privies and privy-vaults 140 

PART IX. 

The Broad Street Pump 142 

Concluding Remarks 159 

Cholera Medical Case 161 



PA RT I. 

oo^oc 

INTRODUCTION. 



" He that writes, 
Or makes a feast, more certainly invites 
His judges than his friends ; there's not a guest 
But will find something wanting, or ill drest." 

It is known that the cholera exists as an epidemic, 
at the present time, in the Old World, and a natural 
feeling of apprehension is extant that this awful and 
desolating plague may turn its course from its an- 
cient haunts toward the shores of America. 

I do not think we should be alarmed in anticipa- 
tion of such an unwelcome visit, yet it will be the 
part of wisdom to prepare for its coming. It may 
not invade our shores for months or years, and 
blessed indeed shall we be if we escape altogether. 
We have, however, no good reason to hope for such 
a favor. It is well, then, to be prepared, so that 
when the mysterious, death-dealing fiend makes his 
approach, we may be the better able to- resist his- 
attacks. 

In presenting this little work to the public, my 
object is, in all sincerity, to place in the hands of 
the people the means of guarding against the inva- 
sion of this terrible disease. The suggestions made 

(3) 



4 HISTORY OF THE CHOLERA. 

as to the treatment of cholera are mostly the result 
of diligent observation and personal experience dur- 
ing the prevalence of the epidemic in 1849, 1850, 
and 1851. 

During that period, I was almost constantly in its 
midst. I came in contact with it at all times, and 
in all its phases. The first case that came under my 
observation occurred on board a steamboat, while on 
my way from Cincinnati to St. Louis. The " Cali- 
fornia fever " was then raging in all its fury, and 
thousands from every section of the country were 
rushing to the newly-discovered "El Dorado." Like 
every other boat bound in that direction, our craft 
was crowded with gold hunters, all eager, anxious, 
excited with visions of wealth, hastening toward the 
rumored mines of exhaustless treasures. The report 
had been started, while at Cincinnati, that several 
cases of cholera had occurred on board of a boat 
lying alongside of us. The passengers became 
alarmed, and but a few hours after leaving the 
landing, anxious inquiries were heard for a " doc- 
tor.'' A man on the lower deck had been at- 
tacked with cholera. 

I found the victim to be a deck passenger. While 
on shore in Cincinnati, he had been drinking freely, 
and in a state of intoxication had fallen asleep on a 
pile of grain sacks. In this condition his friends 
had brought him on board the boat. A sudden 
attack of diarrhea, accompanied with great pain, 
distress at the stomach, and vomiting, awoke him 
from the stupor into which he had fallen. In this 
condition I first saw him. He was a strong, power- 



INTRODUCTION. 5 

ful man, about thirty-two years of age. Laudanum, 
camphor, red pepper, and brandy had been given 
him, without alleviating the symptoms. Shortly 
after I first saw him, he was attacked with spasms, 
in the fingers, toes, and muscles of the legs ; he was 
covered with a cold, clammy sweat ; his body grew 
cold to the touch; his features were contracted; the 
flesh on his extremities shrunken and in ridges, and 
the pulse could scarcely be detected. His eyes were 
sunken deep in their sockets ; his skin became of an 
irregular, spotted, leaden color. He rapidly sunk into 
a listless, torpid condition, and died about thirteen 
hours after he awoke from his drunken stupor. Un- 
questionably this was a case of malignant cholera, 
in its most violent aspect. 

From this time until our arrival in St. Louis, great 
alarm existed on board, and several new cases oc- 
curred, the greater number of which terminated 
fatally. 

Two other physicians were on board, and the 
treatment we adopted, as well as the circumstances 
would permit, were in accordance with the sugges- 
tions advanced by distinguished medical authorities 
of Europe and America. 

Except in a few instances, where the remedies 
were applied at the very outset of the disease, our 
efforts were unavailing. Subsequent experience con- 
vinced me of the folly of attempting to correct the 
disturbance of the functions by pouring medicines 
into the stomach of a person, to be almost immedi- 
ately thrown off by vomiting or purging; and the 
ordinary means resorted to to allay the irritation of 



6 HISTORY OF THE CHOLERA. 

the stomach and bowels were, in severe cases, al- 
most entirely inert, or their action so slow that the 
patient sunk into a lethargic state, the sure fore- 
runner of death, before the desired reaction of the 
vital organs could be established. 

In no city of the Union did the cholera rage with 
more fatal malignity than in St. Louis. The num- 
ber of its inhabitants at that time was estimated at 
about 65,000. On the breaking out of the epidemic, 
however, it was supposed that at least 15,000 per- 
sons sought safety in flight. The majority of those 
who had the means to do so, left the city. The 
population, therefore, during the prevalence of the 
cholera could not have exceeded 50,000. Out of 
this number more than 6,000 died of the disease. 

During the entire time the plague fiend held car- 
nival in that city, I was constant in my attendance 
upon his victims, and while administering, to the 
best of my ability, to the necessities of the sufferers, 
I acquired a fund of knowledge, which I humbly 
trust, by being sent abroad through the medium of 
these pages, may be the means of relieving the dis- 
tress and saving the lives of many, who, in case of 
attack, may be placed beyond the reach of adequate 
medical aid. 

The language made use of is plain, and as free as 
possible from professional technicalities. Through 
this medium, those who are removed from the vicin- 
ity of a competent physician will be enabled to 
adopt a method of treatment, which I am confident, 
if faithfully followed, will afford relief, and cut short 
a disease which, with the advantage of a few hours, 



INTRODUCTION. 7 

yes, even a few minutes' delay, will carry its victim 
to the grave. 

As regards the remedies, treatment, and manner 
of expression adopted, the medical scholar and stu- 
dent have nothing to do. The work is not intended 
for the professional few, but for the many — the 
people. 

However, should any objections be urged against 
the material or style of the work, I assure those for 
whom it was written that I have submitted as much 
of a mode of treatment as is practicable under the 
circumstances, and which, I know, in the hands of 
non-professional persons, in instances where I have 
recommended it, has heretofore proved eminently 
successful. 

I have introduced, at the commencement of the 
work, a brief history of the "Epidemics of the Mid- 
dle Ages." The reader will, I think, find much to 
interest him in this portion of the book. 

Without giving credit, in all cases, in the body of 
the book, to the authors from whom I have selected, 
I desire here to acknowledge my indebtedness for 
the use I have made of Hecker's work on " Epidem- 
ics," Jameson on "Epidemic Cholera," "Payne's 
Letters on Cholera," and "Johnson on Tropical 
Climates." Therefore, do not let the critic say, in 
the language of Hudibras, 

"Much thou hast said, which I know when 
And where 't was stol'n from other men." 



PART II. 

o-oX^o* 

HISTORY OF EPIDEMICS. 



A reliable history of the great plagues which 
have, from time to time, afflicted the human family, 
can not fail to he interesting as well as instructive. 
I have, therefore, compiled such authentic informa- 
tion on the subject as might, with advantage, he 
embraced within the brief limits of a work of this 
description. When we read of the fearful visita- 
tions of pestilence and disease in ages past, and 
compare them with sufferings, from a like cause, in 
our own day, we can not fail to realize how light 
are the afflictions of the present generation, and how 
much reason, therefore, we have to feel grateful for 
the mercies shown us by the great Ruler of the 
universe. When we learn that, in the fourteenth 
century, one- quarter, at least, of the inhabitants of 
the Old World were swept out of existence in the 
short period of four years, and that some countries, 
England among the rest, lost more than double that 
proportion of their populations in the course of a 
few months, we may well congratulate ourselves 
that the visitations of the cholera, terrible as they 
appeared to our affrighted minds in 1832, and more 
recently in 1849 and 1850, has not been like the 
(8) 



EPIDEMICS. 9 

scourges of the past, and feel sincerely thankful to 
the "Creator and Preserver of mankind" for our 
exemption and deliverance. 

As to the causes which have, at various times in 
the history of the world, sent pestilence and death 
throughout the land, human knowledge is not yet 
sufficiently advanced to determine with any degree 
of certainty. Very much, however, has been done, 
through the enlightened scientific researches of the 
age, to arrest the progress of these great evils, and 
to mitigate the sufferings of our fellow-men. The 
votaries of science have looked, with earnest eyes, 
into the mirror of human life, and have zealously, 
and at the risk of their own lives, explored the 
bearings of the phenomena of nature, and closely 
scanned the inexhaustible array of facts and circum- 
stances which could, by any possible chance, have 
an influence upon the laws of particular diseases. 

In this respect, a history of the plagues with 
which the world has been afflicted becomes not only 
interesting to the general reader, but is useful as a 
comparison with similar events in different ages, by 
which the close observer will discover modifica- 
tions of these great evils, in accordance with the 
progression of mankind in the moral, intellectual, 
and physical laws of his existence. Pestilences, 
assume different forms, evidently, as well in their 
modes of attack as in their prevalence and final 
results. In the course and progress of centuries, 
the records of the pestilences that have prevailed at 
different periods, shows us the gratifying fact that 



10 HISTORY OF THE CHOLERA. 

the plagues of our day and generation are mild and 
harmless compared with the past. 

The superstitions of hy-gone ages attributed the 
visitation of scourges to various and singular causes, 
and shows us the depths of ignorance, vice, and 
unbridled passions into which the minds of men 
were plunged. Medical science was, for the most 
part, but a system of jugglery and imposition, and 
the mysterious visitations, which terrified as they 
swept them away, were attributed sometimes to the 
anger of Heaven at the sins of the people. In the 
year 168 of the Christian era, a frightful pestilence, 
which penetrated into every part of the known 
world, was accounted for by the transporting to 
Home of the statue of Apollo, after the taking of 
Selucia. It was remembered that, like the cholera 
of our days, the plague had always come from the 
East. 

That which devastated Rome in 589 spared no 
classes of society. Abbe Pelagius was one of the first 
who fell a victim to it. The year following, 590, it 
penetrated into France, by the way of Marseilles, and 
King Gontran, in a general assembly of notables, 
ordered a general fast to be observed throughout 
the land, for the purpose of appeasing the anger of 
Heaven. The only nourishment allowed to be con- 
sumed was coarse barley bread and water. 

The successor of Pelagius, Gregory the Great, or- 
dered seven distinct processions, composed of clerks, 
monks, religious fraternities, married women, wid- 
ows and children. Still the plague was not stayed, 



PESTILENCE OF THE FOURTEENTH CENTUBY. 11 

and, during a procession, which lasted one hour, 
eighty persons were struck down. 

•• We may smile, or coldly sneer 

The while such stupid thing* we hear. 
And wonder why they were "believed. 
And how wise men could he deceived. 
Bathing our renovated sight 
In the advancing, glorious light, 
We marvel it was ever night." 



PESTILENCE OP THE EOUETEEVrS CEBTTJEY. 

One of the most fearful pestilences that ever 
scourged the earth was that which visited Europe 
and Asia during the fourteenth century. In this 
instance, it was said by the historians of the times 
to have been preceded by mighty revolutions in 
the earth. "From China to the shores of the At- 
lantic the foundations of the earth were shaken, the 
atmosphere was in continual commotion, and endan- 
gered, by its poisonous influence, both vegetable and 
animal life." These terrible convulsions are said to 
have besran in 1333. fifteen veara before the plague 
broke out in China. According to their traditions, 
mine was foil >wed t y : : rrents of rain, and more 
than four hundred thousand people perished in the 
consequent floods. ;, A few months afterward, an 
earthquake caused an extensive range of mountains 
t : -ink and disappear, and instead a lake was formed, 
of more than a hundred leagues in circumference, 
where thousands found a watery grave. w 

Simultaneously with these floods and earthquakes 
in China, the chronicles of Europe tell of uncommon 

9. 



12 HISTORY OF THE CHOLERA. 

atmospheric phenomena, terrific thunder-storms, and 
an eruption of Etna. According to Chinese tradi- 
tions, four million people perished in that region 
during the year 1337. Earthquakes occurred at 
short intervals and of long durations, followed by 
floods, which caused incredible devastation. Great 
floods also occurred in the neighborhood of the 
Rhine and in Erance, which could not be attributed 
to rains, for even on the tops of mountains springs 
burst forth, and the consequent inundations caused 
terrible damage and loss of life. Egypt and Syria 
were likewise visited with fearful commotions. 

These convulsions of the earth continued until the 
year 1347, when the plague, known as the Black 
Death, made its appearance in the East. 

" On the island of Cypress the pestilence had just 
broken out, when an earthquake shook the island, 
accompanied by so frightful a hurricane that the 
inhabitants fled in dismay. The sea overflowed, and 
few outlived the terrible event. Before the earth- 
quake, a pestiferous wind spread so poisonous an 
odor that those who inhaled it expired in fearful 
agonies." In coincidence with this statement, Ger- 
man accounts of that period say that a " thick, 
stinking mist advanced from the East and spread 
itself over Italy." 

The truth of these traditions, however we may be 
inclined to doubt them, can not altogether be called 
into question when we consider the connection of 
events; for the chronicles of that date, in every sec- 
tion of Europe and Asia, make mention of the fear- 
ful devastations of earthquakes more general than at 



PESTILENCE OF THE FOURTEENTH CENTURY. 13 

any other period within the range of history ; and as 
at that time the superstitions of the people transformed 
natural occurrences into miracles, it was stated that 
" a fiery meteor descended on the earth in the East, 
and destroyed every thing within a circumference 
of more than a hundred leagues." 

Divested of the errors of superstition, we obtain 
a glimpse of the truth. "We see innumerable floods 
converting immense tracts of land into swamps. 
As the waters subsided and the flooded districts 
were drained, foul vapors arose every-where from 
decomposing vegetable and animal matter, made 
more horrible and poisonous by the odor of putrified 
corpses, the victims of floods, famines, and earth- 
quakes, which, even in the better regulated countries 
of Europe, they could not remove quickly enough 
from the sight of the living. It is probable, there- 
fore, that the atmosphere, thus contaminated with its 
deadly poison, gave origin to the Black Death where- 
ever the organs of respiration came in contact with 
it, and from thence the destroying angel spread 
pestilence and destruction throughout the land. His 
hand, unstayed by religion, science, or morality, 
sentiments at that time alike dormant and powerless. 

The Oriental Plague, or Black Death, entered the 
western countries of Asia from China, in th e year 
1347, and here the historian obtains the first certain 
knowledge of the character of the disease. From 
China, the route of commerce ran to the north of 
the Caspian Sea, through Central Asia ; from thence 
to Constantinople, the medium of communication 
between Asia, Europe, and Africa. Thus, in all di- 



14 HISTORY OF THE CHOLERA. 

rections, contagion made its way. and doubtless Con- 
stantinople and the harbors of Asia Minor were the 
great centers of infection, whence it spread through 
all the world. 

The plague appeared, in 1347, in Cyprus, Sicily, 
Marseilles, and other seaports of Italy, quickly after- 
ward breaking out in Sardinia and Corsica. It passed 
through the whole of Trance, Germany, Poland, 
and Sweden, and reached England in 1349, breaking 
out in the counties of Dorset, Devon, Somerset, 
Bristol, Gloucester, Oxford, and London succes- 
sively. From England the plague was carried by a 
ship to Bergen, the capital of Norway. In Russia 
it appeared two years later than in Southern Europe. 
Thus, the chroniclers of those days say the fearful 
plague originated 

•■By the imprisoning of unruly wind 
Within her womb, which for enlargement striving, 
Shook the old beldame earth." 



THE HOEEOES OF TEE BLACK DEATH. 

"All sat mute. 
Pondering the danger with deep thoughts; and each 
In other's countenance read his own dismay." 

People were struck down by the Black Death as 
if by lightning, and the young and strong were more 
frequently its victims than the aged and infirm. 
Sometimes it commenced with bleeding at the nose, 
which was a sure si°;n of death. Both in men and 
women, tumours in the groin and the inside of the 
thigh appeared at the beginning. These varied in 



BLACK DEATH. 15 

size, but were frequently as large as an egg. Similar 
tumors appeared afterward all over the body, and 
black and blue spots came out on the arms and 
thighs. These spots were indications of the fatal 
termination of the disease. No power of medicine 
brought relief; almost all died in from one to three 
days, and generally without fever or other symp- 
toms. The plague spread itself with increased fury, 
as it was communicated from the sick to the healthy ; 
and even contact with the clothing, and other articles 
which had been used by the infected, induced the 
disease. As it advanced, not only men but animals 
fell sick and expired if they touched things be- 
longing to the diseased or dead ; multitudes of hogs, 
dogs, cats, and fowls fell victims to the contagion. 
Such was the form which the plague assumed in 
the fourteenth century. Not only individual dwell- 
ings, but whole cities were infected, which in the 
middle ages were, with few exceptions, narrowly 
built, kept in a filthy state, and surrounded with 
stagnant ditches. Flight was of no avail to the 
timid; for, even though they carefully avoided all 
communication with the diseased or suspected, yet 
their clothes were saturated with the pestiferous at- 
mosphere, and every breath they drew imparted to 
them the seeds of the death-dealing malady, added 
to which the propagation of the plague through 
articles of household furniture and a thousand other 
things to which the poison adhered, and which, from 
want of caution must have been infinitely multiplied, 
and which removed from free access to the air re- 
tained the matter of contagion for an indefinite period, 



16 HISTORY OF THE CHOLERA. 

and increased its activity and engendered it like a 
living being; and thus its frightful consequences 
followed for many years. 

After the first fury, however, was spent, the pesti- 
lence passed into a febrile form of what was called 
the " Oriental plague." The tumors no longer took 
place, and spitting of blood was seldom known to 
occur, so that in 1360, and till 1373, cases appeared 
with the black spots of the plague, but all the symp- 
toms were of a milder form, and consequently with 
less fatal results. It has been supposed, by excel- 
lent medical authority, that the form thus assumed 
by the oriental plague, is identical with the cholera 
of the present age, and that the term Black Death, 
applied to it, was derived from the livid and fre- 
quently spotted appearance of patients in cases of 
malignant cholera. 

A distinguished medical writer says : " While we 
express our opinion that the epidemic which visited 
us in 1832 was not a new disease in the great do- 
main of the world, we must admit that, to us of the 
present time, it is as new as though it had never 
existed ; and hence it is that the several countries of 
Europe, like our own, were taken by surprise in 
encountering the disease, the more so from its pos- 
sessing such a vast dominion, and in this respect it 
is new." 



THE MORTALITY OF THE "BLACK DEATH." 

It would be impossible to arrive at a positive 
statement of the numbers who died from this mal- 



MORTALITY OF THE BLACK DEATH. 17 

adv. The people were in a state of ignorance. The 
church, with its corruption and superstition, had 
all classes under subjection. Law and order were 
unknown. Every city was a fastness. Robbers 
encamped in the open fields or by the roadside; and 
the laborer was a feudal slave. Humanity was 
scarcely known. Life was little regarded. Witches 
and heretics were burned alive; and governments 
were not concerned about the numbers of their sub- 
jects. 

" Thus roving on 
In confused march forlorn the lawless bands, 
With shuddering horror pale, and eyes aghast, 
Viewed their lamentable lot, and found 
No rest." 

The first requisites for ascertaining the loss of hu- 
man life — that is, a knowledge of the amount of the 
population — was altogether wanting. The most reli- 
able estimates given, however, state that in China 
more than thirteen millions died. India was almost 
depopulated. Tartary, Syria, and all the adjoining 
countries, were literally covered with dead bodies. 
On the roads, in the fields, and in the cities, un- 
buried bodies alone were seen. Cyprus, it is said, 
lost all of its inhabitants ; and ships without crews 
were seen, long after, floating about in the Med- 
iterranean, and also in the Xorth Sea, and spread- 
ing the plague wherever they drifted ashore. It 
was reported to Pope Clement that in the East, ex- 
cepting China, twenty-three millions fell victims to 
the pestilence. 



18 HISTORY OF THE CHOLERA. 



DEATHS BY THE PLAGUES IN THE PRINCIPAL CITIES. 

TVe give the following table as the result of inves- 
tigations, made by competent authorities, in regard 
to the mortality in some of the principal cities of 
Europe, during a period of four months : 

Florence 60,000 

Marseilles (in one month) 16,000 

Siena 70,000 

Venice 100,000 

Paris 50,000 

St. Denis 14,000 

Avignon 60,000 

Strasburg 16,000 

Basle 14,000 

Erfurt 16,000 

Norwich 51,000 

London 100,000 

It is stated by the German writer Spangenberg 
that of the Franciscan friars in Germany 124,000 
died. All the smaller cities, towns, and villages suf- 
fered incredible loss. In the whole country scarcely 
a tenth part remained alive. 

Of all the estimates of the number of lives lost 
in Europe, the most probable is that, altogether, 
a fourth part of the inhabitants were carried off. 
The population of Europe at that time certainly 
amounted to one hundred millions. It may there- 
fore be reasonably assumed, without exaggeration, 
that Europe lost from the Black Death twenty-five 
millions of inhabitants. 

In many places in France not more than one out 
of every ten inhabitants were left alive; and the 
fury of the plague was felt alike in the palace and 



MORTALITY OF THE BLACK DEATH. 19 

the cot. Churchyards were unable to hold the 
dead, and houses, left without inhabitants, fell to 
ruins. In Avignon the Pope consecrated the Rhone, 
so that bodies might be thrown into it, as the quick- 
est way of disposing of them. In Vienna the dead 
were thrown into immense pits outside of the city 
by thousands, as was also done in other large cities. 

In 1350 the Black Death had so far subsided in 
Italy, that Pope Clement YI invited the faithful to 
Rome to join in the celebration of a grand jubilee. 
This gathering of such a large body of people so 
prematurely was followed by a new eruption of the 
pestilence, from which, it is said, scarcely one in a 
hundred of the pilgrims escaped. 

Italy was, in consequence, depopulated anew, and 
those who returned spread the poison in all direc- 
tions. The chronicles of the times remark that it 
was "somewhat singular that Pope Clement should 
have adopted so dangerous a measure as calling 
together such crowds of people, since he himself 
was so convinced of the salutary effect of seclusion 
that he kept up constant fires on his grounds, and 
suffered no one to approach him." 

The inhabitants of Iceland and Greenland did not 
find, as might have been supposed, protection against 
the plague in the coldness of their climate; for, 
after its introduction from southern climates, it 
spread great havoc among them. In Denmark and 
Norway people were so overcome with their afflic- 
tions that all travel and communication with other 
countries ceased, and they gave themselves up to 
despair. 



20 HISTORY OF THE CHOLERA. 

In Russia the Black Death did not break out 
until 1351, after it had passed through the south 
and north of Europe. But the mortality was 
fearful, filling the nation with scenes of suffering, 
death, and despair; and there the voice of nature 
was silenced by fear and horror. Parents deserted 
their children, and the closest ties of relationship 
were altogether unheeded. As in every country 
visited by the plague, the wealthy abandoned their 
treasures and gave their riches and estates to the 
churches and monasteries. Merchants whose wealth 
was unbounded, renounced all their earthly goods, 
and carried their treasures to the monks and priests, 
this being, according to the notions of the age, the 
surest way of securing the favor of Heaven — 

"As carnal seamen in a storm, 
Turn pious converts and reform" — 

thereby hoping to obtain exemption from their afflic- 
tions. But wealth had no charms for the monks and 
priests at this time, for it only brought them death 
by its infection, and the gates of the convents and 
churches were closed against the people. Amid 
this general lamentation and wo, every law, human 
and divine, was disregarded. The officers of the law 
were either dead or had fled for safety, and every 
one was left to act without restraint. The people 
who did not seek safety in flight, carried odorifer- 
ous flowers and herbs with them, when they ven- 
tured abroad, to avert the baneful influence of the 
air. One citizen fled from another; relation from 
relations. Every kindly feeling was extinguished, 
and those who stood in need of assistance fell a prey 



THE FLAGELLANTS. 21 

to attendants greedy for gam, who, for exorbi- 
tant charges, and with the hope of plunder, merely 
remained with them till the last moment, and then 
became, in almost every instance., themselves the 
victims of their own avarice. 

Females of rank forgot their natural bashfulness, 
and gave the care of their persons to male attend- 
ants. With large numbers, instead of sorrow and 
mourning appeared dissipation and mirth, which 
females especially seemed to consider conducive to 
health. 

Poverty compelled large numbers of the lower 
classes to leave their dwellings in search of food, 
and thus they fell by thousands in the streets, both 
by day and night; while the bodies of those who 
died in their houses were placed in the street by the 
survivors, if there were any; and thus they lay in 
heaps, exposed to the gaze of the affrighted passers- 
by, while the stench that filled the air was horrible. 



THE FLAGELLANTS, 



We have said that one of the prominent effects of 
the Black Death was an awful sense of contrition 
for past sins; repentance seized the transgressor, and 
his first thought was to propitiate the Divine wrath, 
to make restitution, and seek reconciliation by self- 
chastisement as their just punishment. 

In the fourteenth century, the monastic system 
was in its full vigor. Ecclesiastical orders were 
looked upon with superstitious reverence by all 



22 HISTORY OF THE CHOLERA. 

classes of the people. It was natural, therefore, that 
self-willed penitence and bigoted zeal should control 
the minds of men. 

While the nations were filled with lamentations 
and woe, there originated in Hungary and Germany 
the sect known as the Flagellants. The order con- 
sisted of persons mostly from the lower classes, who 
took upon themselves to do penance for the sins of 
the people, and thus, by prayers and self-punish- 
ments, avert the ravages of the plague. The order 
was welcomed every- where by the nobles and eccle- 
siastics, who were encouraged with the superstitious 
idea that through them God's vengeance might be 
stayed. 

The members of the order wandered through the 
streets with eyes fixed on the ground, accompanied 
with every evidence of contrition and mourning. 
They were clothed in somber garments, and carried 
scourges tied with several knots, in which sharp 
pieces of iron were fixed. They performed penance 
in some public place twice every day, by scourging 
themselves, amid the singing of psalms and loud 
supplications for the averting of the plague, in which 
the people joined; and from these ceremonies, orig- 
inating in the grossest delusion of religious zeal, no 
doubt great consolation was derived, although it is 
highly probable that the processions of the order, 
and the consequent gathering of the people in the 
public places, had a tendency to promote the spread 
of the pestilence. 

The proceedings of the Flagellants appears to us 
like the insane actions of men prompted by religious 



THE PERSECUTIONS OF THE JEWS. 23 

frenzy and fear. May we not find, in the conduct 
of pious zealots occasionally, at the present day, 

" That mad as Christians used to be 
About the fourteenth century, 
There 's lots of Christians to be had 
In this, the nineteenth, just as mad." 



THE PERSECUTIONS OP THE JEWS. 

The idea took possession of the minds of the peo- 
ple that the horrible plague which was desolating 
the land was caused by poison ; and on whom would 
the suspicion of its origin be so likely to fall as on 
the Jews ? — 

" Ejected out of Church and State, 
And all things but the people's hate " — 

a race opposed by all their religious and fanatical 
fury. They were accused of having poisoned the 
wells, and, by their superior knowledge of alchemy, 
to have found means to infect the air. They alone 
were considered as having brought this fearful mor- 
tality among the Christians. In consequence, they 
were pursued with merciless cruelty, and indiscrim- 
inately given up to the fury of the populace ; or, if 
brought before the tribunals, they were buried alive, 
with the form and sanction of the law. 

Scenes like these had their counterpart in the 
seventeenth century, in the hanging and roasting of 
witches and sorcerers. 

The persecutions of the Jews commenced in Sep- 
tember, 1348. The charge against them found a 
response in every country where the plague had ob- 



24 HISTORY OF THE CHOLERA. 

tained a place for its work of death, and where Jews 
had found a foothold, and Christians every-where 
bound themselves by an oath to extirpate them by 
fire and sword. In Basle, all the Jews, without sen- 
tence or trial, upon the outcry of the people, were 
inclosed in a large wooden building, constructed for 
that purpose, and burnt together. The same thing 
took place at Freyburg. At Spires, the Jews, driven 
to despair, assembled in their own houses, and set- 
ting them on fire, consumed themselves with their 
families. At Strasburg, two thousand were burned 
alive in their own burial-ground. At Eslingen, the 
whole Jewish community were burned in their own 
synagogue. Wherever the Jews were not put to 
death, they were banished, and so, being compelled 
to wander about, fell into the hands of the country 
people, who gladly became their executioners. A 
few Jews saved their lives by baptism, but these 
were afterward burned at different times, so that 
scarcely any escaped. 

Clement VI, an exception to the general blind- 
ness and misguided fury of the times, attempted to 
protect the Jews, as far as lay in his power ; but this 
high ecclesiastical dignitary could not restrain the 
nnbridled madness of the people. The Emperor, 
Charles IV, also sought to avert their destruction 
but he dared not draw the sword of justice in their 
defense, and was obliged to yield to the demands of 
his nobles for their annihilation— perhaps, as was 
suggested by an ancient historian, "to free them- 
selves from their indebtedness to the Jews, who 
were their creditors in large amounts." 



THE PERSECUTIONS OE THE JEW?. 25 

Those of the Jews who could make their escape 
found refuge in Lithurnia; also in the realms of 
Boleslav V. Duke of Poland, who granted them pro- 
tection and liberty of conscience, and in the domin- 
ions of Kino: Cassimar the Great, who received and 
gave them favor at the entreaties of a beautiful and 
favorite Jewish mistress. 

Strange as it may appear to us in this enlightened 
age. the superstition which gave rise to the persecu- 
tions of the Jews in the fourteenth centurv has an 
existence at the present time. The belief in the 
administration of poison has been handed down 
from the days of barbarism, and in the year 1865. in 
Naples, we rind the same ignorance attributing the 
cholera to the same cause. A recent correspondent 
of the London Times says: "I have myself been 
assured, by really sober and decent persons, that 
poison is thrown into the air. A few days only have 
passed since some doctors were sent to disinfect a 
house in which a cholera patient had died: but a 
crowd assembled, and, with howling and whistling, 
drove them away, and compelled them to take 
refuge in the nearest police-office. In another house, 
a woman lay sick of cholera, on straw, in a damp 
room, without the comforts of even the necessaries 
of life, when a guard of public security and a doctor 
were sent to carry her to the hospital. On this, all 
the women in the neighborhood rose as one man, I 
was about to say, and compelled them to fly. Thus 
the authorities, to a certain extent, are impotent; 
medical men fear to dispense their own medicines, 
and do not escape danger by writing prescriptions, 



26 HB3T0BY 01 THE CH:ir 

as they are said to act in combination with, the drug- 
-. It is to be hoped that cholera will not present 
itself in a dangerous form, but should it do so. we 
should be in a bad state. The belief in the admin- 
istration of poison is, however, as old as barbarism; 
it has always existed when any epidemic has pre- 
vailed in the South, and during the last visitation 
of cholera in Palermo a benevolent English lady 
found it necessary to her own personal safety to sns- 
pend her attention to her poor neighbors.' 7 

The fallacy in regard to poisoning of the atmos- 
phere was terrible in its results, because it arose at 
a time when law and the officers of the law were 
powerless, and forced to yield to the impressions of 
the multitude. Whatever the will of the authori- 
fies mav have been, thev could not enforce it. as was 
illustrated in the case of the Count of Savoy, who 
had sriven the Jews shelter in his Castle of Cham- 
bery; but the populace, exasperated and terror- 
stricken, attacked the castle, broke open the gates, 
and massacred manv of those who had sousrht refuse 
within its walls. The Count, however, repulsed the 
mob. and handed the ringleaders on the battlements. 
But even he soon adopted the popular prejudice 
against the Jews. He brought to trial those who 
:- - : aped being torn to pieces : they were condemned 
to death, and were burned in an old barn. 



LEPROSY. 27 



THE LEPROSY. 

The plague was not the only visitation in these 
times; there was also leprosy. The description of 
this hideous malady is painfully graphic. It also 
came from the East, like the plague, though, accord- 
ing to Pope Stephen, who wished to discourage the 
marriage of Carloman with a daughter of Diclier, 
King of Lombardy, the leprosy came from that 
country, as he stated in a letter to his niece Bertha. 

In the early part of the fourteenth century the num- 
ber infected with leprosy was considerable. They 
were driven out of every city, out of every monas- 
tery, as out of every earth; now the wretched out- 
casts wandered in bands through the country, and 
sometimes encamped in the neighborhood of small 
towns. In 1321 the rumor spread on both banks 
of the Rhine that those miserable creatures, inspired 
by the demon through the agency of the Jews, 
imagined that if they could find the means of com- 
municating their own horrible malady they should 
have a share in the wealth and grandeur of man- 
kind. To attain this object, they were said to have 
corrupted the water with certain poisoned powders, 
and forthwith they began to give each other the 
titles of count and baron. The populace rose and 
hunted them down; many were caught and burned 
alive, and others sentenced to die of hunger. 



28 HISTORY OF THE CHOLERA. 

THE PARISIAN DOCTORS, 

The report of the commission of medical men, 
appointed by the Government of France, is a very 
singular document to emanate from learned men 
even in the fourteenth century. It serves to show, 
however, the depths of ignorance into which all 
classes had fallen. Their claims to superior knowl- 
edge, as to the causes of the plague, and their elu- 
cidation of the mystery, reminds us of blind men 
walking, 

Who always carry their noses higher I 
Than those who have their eyes and sight entire; 
And who, while striving to avoid a fall, 
Flounder in the dirtiest mud of all. 

The document of the Parisian doctors is sufficiently 
curious to interest our readers. We give place to a 
portion of it: 

"We, the members of the College of Physicians 
of Paris, have, after mature deliberation and con- 
sultation on the present mortality, collected the ad- 
vice of the old masters in the art, and intend to 
make known the cause of the pestilence more clearly 
than could be done according to the rules and prin- 
ciples of astrology and natural science. We, there- 
fore, declare as follows: 

-"It is known that in India, and the vicinity of 
the Great Sea, the constellations which combated 
the rays of the sun and the warmth of the heavenly 
fire exerted their powers especially against that sea, 
and struggled violently with its waters. Hence 
vapors often originate, which envelop the sun and 



THE PARISIAN DOCTORS. 29 

convert his light into darkness. These vapors alter- 
nately rose and fell for many days, but at last the 
sun acted so powerfully upon the sea that it attracted 
a great portion of its waters ; thereby they were so 
corrupted that the fish which they contained died. 
These corrupted waters, however, the heat of the 
sun could not consume ; neither could other whole- 
some water — hail, snow, or dew — originate there- 
from. This vapor spreads itself through the air and 
envelops the earth in fog. If the inhabitants on 
all the adjoining islands and countries to which the 
corrupted sea- wind extends do not comply to the 
following, or similar means and precepts, we an- 
nounce to them inevitable death, unless the grace 
of Christ save them:" 

"We are of opinion that the constellations, with 
the aid of - nature, strive, by virtue of their divine 
might, to protect and heal' the human race, and to 
this end, in union with the rays of the sun, endeavor 
to break through the mist which will be converted 
into a deleterious rain. Now, as soon as this rain 
announces itself by thunder or hail, every one of you 
should protect himself from the air, and, as well 
before as after the rain, kindle a large fire of vine 
wood, green laurel, or other green wood, which should 
be burnt in great quantity in the market places and 
in the houses, until the earth is again completely 
dry, and for three days afterward no one ought to 
go abroad in the fields." 

These learned doctors then give a long list of 
articles to be eaten, and others to be avoided. 
"Fruits," they say, "are highly injurious without 



wine. If it rain, treacle (molasses) was recom- 
mended and good wine in abundance. Olive oil 
declared fatal. Fat people were not to eat or 
sit in the sunshine, and never to indulge in the 
luxury of a bath." 

These were strange precepts to emanate from the 
li?5: --:.:i-~. ziiiLzs :: :be z:~zz-rizzz'z :tZ.:z:~\ ":.;: 
-_t ::::^:~:: r^jiier —:'.".. n: :::-.:!:, ::~:\'iii :'i:r. 
they are quite as sensible as many of the theories 
and absurd notions, in regard to the cause and treat- 
ment of diseases, prevailing at the present time 

In :;. ;: :le :jzi:~ = z:-.yzizj :: I^ris ~-z- z'.iz^l 
in the same predicament that some of the professors 
of the present day are. They are under the neces- 

:-f" Lil"ili:-r :~ 3 _ : "r^::i :: ^7-^:7. :'_r :r'ir :-_ir:.-_- 
ing of which they, as well as the world at large, 
are totally ignorant. 

There is no doubt but that these physicians and 

'.^xtzz^I L_fL ~r:f siii^rr celievrrs '.- :le :ii:T::T 
of the planets on human diseases; but instead of 

:"!-.=: :: i:i::~er zj ~'lz.z Li— :lesr :!:::; ~ r7r 

:■: :_.t':- ni zzr.iz 1 .: ■;.= l:-:::zs. ani :Li= :Vz: ::ez- 
selves in a continued state of bewilderment. They 
believed the constellations all potent as the cause of 

:_r ^r5::lri:r. -z.z.1 :L;.: :1c rrrrerrr:: an I ::s:n::ci 
laws of nature were but subordinate causes aggra- 

~a:i::r :le re=il:. 



A SHAHS PHEHOMBH09. 31 



A StAIS PHEF0ME503T. 

The historian mentions, and with profound gravity. 
what he calls "a remarkable circumstance — a grand 

phenomenon: n viz.. the wonderful fertility of women 
after the cessation of the pestilence. •• Marriages 
were, almost without exception, proline, and double 
and treble births were more frequent than at other 
times.*' 

W;^5er=. I'sni^ vrill never eeasc^ 
Young and old women still increase, 
Secundum naiuram, the race; 
Children, like mushrooms, spring apace. 

;, lt was also remarked that after the ; great mor- 
talitv ' the children were said to have got fewer 
teeth than before.*'* This latter statement led to a 
protracted and learned discussion, which, having 
continued, on the part of the most eminent doctors 
of the age, for many years, without seeing for them- 
selves, was rinally settled to the satisfa :::on of all 
on discovering that children, as they had done be- 
fore, cut about the same average number of tec:_. 
and, no doubt, women bore about the same average 
number of children. A few other vagaries served, 
from time to time, to create exciting subjects of de- 
bate as connected with the terrible plague: but the 
re.ple gradually consoled thr_- ; rives after the suf- 
ferings they had undergone. The millions of dead 
e forgotten, and the whirl and bustle oi exist- 
ence brought men back to the reality that the world 
still belonged to the living. 



_a_ 



i_ 1 



1J 



zz-zzzyo: 



Li : : 11 -. _ ! : _ - i . : _ ; : : : i - ._ : ; : 

-1- . — -'_'. — . — . - — . - _ 



the : aj •-.::■•.- epidemic. S3 

It did nor remain confined to one particular locality, 
but ^as disseminated, like a spirit of evil, by the 
sight of the sufferer, and spread through. Germany 
and thence through all parts of Europe, 

THE VICTIMS. 

Those who were under the iniluenee of this strange 
delusion appeared to lose all control over their sense s. 
They formed circles, hand-in-hand, and continued 
dancing, regardless of observers, or, in fact, of all 

:rum, for hours together, in wild delirium, until 
at length they fell to the ground in a completely ex- 
hausted state. They then complained of extreme 
oppression, and groaned as if in the agonies : : :.:;_. 
Their abdomens became enlarged, and until they 

e bound tightly around their waists with clothes 
thev were not relieved. "While dancing, :Lr~ d i:her 
saw nor heard, being insensible to surrounding ; - 
cumstanc -. :.nd haunted with visions of supernat- 
ural things — the relisdous notions ji the _; having 
predominance in their minds. Where the dises se 
- completely developed, the patient fell to the 
ground senseless, anting, laboring for breath, and 
foaming at the mouth; then, suddenly springing 
began again the strange dance and contor- 
tions. As s vathing of the body was the popular 
remedy, many wore a cloth begirt about their w aists, 
so that they might receive immediate relief from 
the bystanders, when the paroxysm was aver, who, 

inserting a stick, could tvris: i: tight and com- 
press the swelling of the belly, thus relieving their 
sufferings. 



34 HISTORY OF THE CHOLERA. 

These frightful spectacles were seen in every town 
and village. Peasants left their plows, mechanics 
their workshops, wives their domestic duties, to join 
the wild revels. Secret desires were excited, and 
found relief in wild enjoyment. Young girls and 
bovs. vonns: men and nnmarried women, of hitherto 
unblemished morals, greedily imbibed the mental 
poison. And thns the disgusting plague spread on, 
and found abundant food in the tone of mind which 
prevailed in the fourteenth and fifteenth centuries, 
and the effect was. in manv instances, to cause a 
permanent mental disorder. 



ST. VTTTJS'S DAIfCE, 

'■'The universal frame's 
B : loose, that it but wants another push 
To leap from its hinges. 

The dancing plague took the name of St. Titus's 
Dance, because it was said that those who went to 
the chapels of this saint for help, on being instructed, 
commenced dancing to the strains of music, until 
they were completely cured. Thus St. Vitus be- 
came the patron saint of those afflicted with the 
plague. 

The sufferers were led to the altars of St. Titus on 
foot, or conducted in carriages and other modes of 
conveyance, accompanied by musicians, who would 
play so long as the patients could stand, when, being 
completely exhausted, they were freed from the dis- 
ease. 



st. John's dance. 35 



ST, JOHN'S DANCE. 

This malady also took the name of St. John's 
Dance in many parts of Germany. At this period 
the Germans gave way to Bacchanalian dances, and 
other wild orgies, while keeping the festival of St. 
John the Baptist. Thence there is good reason for 
supposing that the frantic celebration of the day 
only served to aggravate a malady which had been 
raging with disgusting fatality to the minds of men. 

As to its physical character, it may be readily un- 
derstood, by the intelligent reader, how an indul- 
gence in such protracted and fatiguing exercise, and 
such strange distortions of body, could degenerate 
into so serious a disease. "With the excitement of 
mind there was a neglect of proper food and nour- 
ishment for the body. The stomach and bowels 
were debilitated by hunger; as a consequence, they 
were attacked with excruciating pains and swell- 
ing of the abdomen. The bindiug of a cloth 
tightly around the body afforded relief temporarily, 
as we know that the pangs of hunger may be ap- 
peased, in a great measure, by the same means. 



DECLINE OF TEE DANCING PLAGUE. 

After extending its baleful influences through all 
the countries of Europe, about the latter part of the 
sixteenth century it began to decline. Its attacks 
became milder, and were observed at greater inter- 
vals, although a writer of that day alludes to cases 
of extreme violence. He says the fury and extrav- 
4 



36 HISTORY OF THE CHOLERA. 

agance of demeanor of the patients so completely 
deprived them of senses, that many of them dashed 
their brains out against the walls and buildings, or 
rushed headlong into rivers, to find a watery grave. 
It appears, however, that such cases as these were 
of rare occurrence. 

THE REMEDIES. 

Until about the beginning of the seventeenth cen- 
tury, the dancing plague was made altogether the 
subject of religious treatment. Believing it to orig- 
inate in unhallowed demoniacal influences, the 
church took special charge of the victims, and the 
priesthood made it their sole business to exorcise 
the evil spirits. "While the people believed in the 
power of the church to cast out the malady, great 
indignation was also felt among them, because the 
belief had been promulgated that the frightful afflic- 
tions originated with innocent children, who had 
been baptized by unchaste and libidinous priests; 
and thus, in after years, they were made to atone 
for the sins of the unholy members of the church. 

Physicians never undertook the treatment of the 
dancing mania. Against demoniacal disorders they 
had no remedies. It was observed that patients 
were violently affected by music, and that the par- 
oxysms were increased by it. On this account, the 
magistrates hired musicians for the purpose of 
bringing the disorder to a crisis, and the priests en- 
couraged the musicians to play at the altars of the 
saints, telling the patients that if they danced there 
they would be cured. 



TARANTISM. 37 

TAEANTISM, 

This form of the dancing mania prevailed through- 
out Italy. There is no question but that the malady 
bore a close connection with the St. Vitus Dance ; 
and. although it was generally believed that the dis- 
ease originated in the bite of a venomous spider 
called the Tarantula, the symptoms were almost 
precisely the same. The patients behaved like ma- 
niacs, throwing their arms about in the wildest 
manner. Commencing in spasmodic dances and 
music, (for which the inhabitants of Italy manifested 
more than ordinary susceptibility and talent,) they be- 
came capable of exciting in them ecstatic attacks, 
and these furnished the means of exercising their 
malady. Cities and villages resounded with the 
notes of fifes, clarionets and drums : 

11 And there was songs and quavers, roaring, humming 
Guitars, and every other sort of strumming."' 

It was the general conviction that by music and 
dancing the poison was distributed over the body 
and expelled through the pores of the skin. As an 
evidence that the mania did not proceed from the 
bite of a poisonous insect, it was stated that in- 
quisitive females joined the throng of dancers, 
simply to gratify their curiosity, and thereby caught 
the disease, and themselves became the victims. So 
many subjects were thus added to the crowds of 
sufferers that it became customary, early in the sev- 
enteenth century, for bands of musicians to travel 
from town to town, and from village to village, 
throughout the country, and institute carnivals on a 



38 HISTORY OF THE CHOLERA. 

grand scale for the cure of Tarantisru. These danc- 
ing festivals were in consequence called the " Wo- 
men's Carnival."' 

The music employed was of various kinds, adat I 
to the different moods of the patients. There was 
the lively and impassioned, the sentimental, the 
grave and solemn, the spasmodic and exciting, and, 
in fact, all the grades most likely to meet the pecu- 
liar moods of the dancers. 

It is thought by many that the St. Vitus Dance 
and Tarantism were different and distinct maladies. 
Tarautism was certainly cotemporaneous with the 
St. Titus disease, and both evidentlv originated un- 
der the influence of the church, connected, as it was 
in those times, with all manner of superstitious no- 
tions, with public exercises of penance, and with 
innumerable practices calculated to excite the imag- 
inations of its votaries and brine the mind into a 
state favorable for the reception of nervous disorders. 
The only difference between the disease as it ap- 
peared in Italy and the St. Vitus Dance, was that the 
people sought for the cause of Tarautism in the bite 
of a venomous spider, whereas its origin in other 
parts of Europe was attributed to the sins of unholy 
priests and various other mysterious causes. 

So long as religious doctrines were blended with 
so much superstition these disorders prevailed, so 
that every country under the domination of the 
church was visited; and we find in our own dav 
examples of similar diseases, though in a modified 
degree, in certain localities, where the enlightened 
views of the age have not penetrated, and with cer- 



TARAXTISM. 39 

tain sects, still blinded by zeal, who madly labor to 
drag every weak mind into their toils. 

• ; >~o wild enthusiast ever vet could rest, 
'Til half mankind were, like himself, possessed." 

Combined with religious enthusiasm, imagination 
and sympathy exert a powerful influence over every 
passion and quality of the mind. The nerves con- 
vey the sensation to the spinal cord, the whole cor- 
poreal system is affected, and disease results ; pre- 
existing disease is aggravated, and the foundation is 
laid for various malarious, contagious and epidemic 
disorders. 

In our brief history of the epidemics of the Mid- 
dle Ages, the close observer will discover the exist- 
ence of a morbid sympathy, by the aid of which 
mental disorders may be originated and grow into 
real epidemics, involving the physical functions. 



PART I I I. 



-:-:'--^':- 



HISTORY OF EPIDEMIC CHOLERA. 



And lifts 19 its roiee like the angel rf death." 

It is generally supposed that the disease now 
known as the "epidemic cholera" first mad- 
appearance on the banks of the Ganges, in 1817. 
There is good authority, however, for believing that 
it had an existence if ■ mnch more remote period, 
and may have been identical with the modified form 
of the scourge called the Black Death, which devas- 
tated the earth in the fourteenth century. I: h 
very probable that we are not acquainted with all 
the visitations of this fearful dh ea ise. 

The first accounts which would seem to mark its 
appearance with any degree of positiveness are 
given by Dr. Bontius, a physician attached to 
Dutch Bast India Company. His book was pub- 
lished in Batavia in 1629. In describing what he 
calls an epidemic cholera-morbus, he says: "1: 
disease of the most acute kind, and, therefore, re- 
quires immediate application. The animal spirits 
are speedily exhausted, and the heart, the fountain 
of life, is overwhelmed with putrid effluvia. Those 

(40) 



EPIDEMIC CHOLERA. 41 

who are seized with this disease generally die, and 
that so quickly as in the space of twenty-four hours 
at most. This disease is attended with a weak 
pulse, difficult respiration, and coldness of the ex- 
treme parts ; to which are joined great internal 
heat, insatiahle thirst, perpetual watching, and rest- 
less and incessant tossing of the body. If, together 
with these symptoms, a cold and fetid sweat should 
break forth, it is certain that death is at hand. 

Although treating of what he called cholera-mor- 
bus. yet it can scarcely be doubted that the disease 
he describes was, in reality, the spasmodic cholera, 
and the account he giyes of the death of a patient 
with this disease leayes no room for any other con- 
clusion. In the case alluded to, he says the patient 
"was suddenly seized with cholera, about six o'clock 
in the eyening, and expired, in terrible agony and 
convulsions, before twelve o'clock at night." This, 
then, appears to be the first well-authenticated rec- 
ord of the spasmodic epidemic cholera." 

During the latter part of the seventeenth century, 
and until the year 1774, the cholera appeared to 
have confined its ravages almost exclusively to the 
Hindoos. Hindoo writers often speak of it, and 
Hindoo practitioners appear to have been familiar 
with its symptoms, or at least a disease closely 
resembling it, which they called " Vishuchi," a term 
in their language signifying vomiting and purging. 

The term cholera is now used by universal con- 
sent, and was adopted at the very earliest period of 
the appearance of the disease in Europe. Cholera- 
morbus signifies that form of disease wherein the 



42 HISTORY OF THE CHOLERA. 

bilious discharge characterizes the secretions from 
the bowels, and where the circulation is not un- 
usually depressed. Spasmodic or epidemic cholera 
is that form of disease wherein bile and other nat- 
ural secretions cease to flow, and where the pulse 
sinks or entirely ceases to be felt. 



THE CHOLERA IN INDIA. 

In no portion of the globe does this terrific dis- 
ease appear in a more violent or fatal form than in 
India, the climate and scenery of which seem cal- 
culated to engender and keep alive the dreadful 
poison. Especially is this the case on the eastern 
coast of Ceylon. 

" The mountains tower to a great height, in fan- 
tastic shapes or conical peaks, clothed from base to 
summit with almost impenetrable forests of lofty 
trees, underwood, and jungle. Deep vallies and 
ravines, still more thickly covered with similar ma- 
terials, and choked up, as it were, with all the wild 
exuberance of tropical vegetation, separate the mount- 
ains from each other, and swarm with myriads of 
animals and reptiles. From these valleys, in the 
months of May, June, and July, when the south- 
west monsoon is in force, the gusts of land wind 
come down hot and sultry by day, but chilling, 
cold, and damp by night. Where mountainous and 
woody, or flat, marshy, and jungle tracts border on 
the sea, atmospherical dangers will be greater than 
where the coast is gravelly or dry and cultivated.' 

During the months alluded to, when the south- 



CHOLERA IN MADRAS. 43 

west monsoon passes with great strength over Cey- 
lon, the wind by day is hot and sultry, and as soon 
as the dews have fallen in the evening, and evapor- 
ation commences from a very extended surface, the 
land breeze is instantly cold and raw; and being 
then loaded with vapor, together with all kinds of 
vegetable exhalations, penetrates our frames and sys- 
tems with its deadly poisons. The effects of these 
atmospheric changes are fearful even to the natives. 
The following digest of the report of the " Medi- 
cal Commission" of Bengal and Madras embraces a 
period of forty-two years, from 1774 to 1817. The 
symptoms described so closely resemble the cholera 
of the present day that the identity seems almost 
complete. 

THE CHOLERA IS MADRAS, 

In the first campaigns of the British troops in; 
India, in the year 1774, the cholera, presenting all 
the symptoms known to characterize the epidemic, 
made its appearance at Madras, and proved very 
fatal to both the European and native soldiers, car- 
rying them off very quickly after they were attacked. 

It is asserted, on good authority, that more than 
sixty thousand people perished between the years 
1774 and 1781. The poorer classes were more fre- 
quently the victims, and it is stated that the native' 
physicians could not save a single person. Those who 
were attacked had as many as thirty evacuations in 
from five to six hours. They were often without 
pulse. The hands and ears were cold, the face 
lengthened ; the sinking of the socket of the eye was 
5 



^ They felt 

ais very much like the real epi- 



:Lr ' -r.-. := 1 



T -TT-,1 






:::z -.•-.:• -is. 4o 

re generally dead, or past recovery, within less 
than an hour. 



1 i \ ".~Z 



In the year 1783, the cholera broke ont at the 
sacred bathing-place on the Granges called Hurdwar. 
Every twelfth year i: is deemed peculiarly obligatory 
on the Hindoo to assemble at this spot. This was 
ar for the great pilgrimage, consequently a 
far greater number than usual were drawn hither 
at this time. Two million pilgrims, it is said, were 
enibled on the banks of the Granges. 

" The disease broke out on the springing up of an 
easterly wind during the night, carrying off innu- 
merable trtsi.ns." In Less than eight days twenty- 
tho:tsand fell vi::ims. I: :li:l ::". h:~ever. extend 
beyond the place of bathing, and ceased upon the 
dispersion of the multitude. In 1710, the cholera, 
in a violent and fatal form, attacked the British. 
troops and also the natives. 

It appears evident that epidemic cholera prevailed 
at various periods, sometimes coming as a desolating 
tes:ilen:e. spreading Its ~:rk :: rerrtr far an :I -vide. 
and at other times confining its destra stive Infl :;en : « s 
::■ a rarhealar l::al::y :r 11-:::::. ZVj vrsitatltn. 
er, of the disease approached, in duration, 
severity, and fatality, that which took He rise, in 
1S1T. en :lre banks :: :lre G-anges. These steering, 
destlatlr.g eallrnah-s were an yaestirnaf ly ma:le the 
more terrible by the laxity in social and moral life. 
Under the improvements which have been insti- 
tuted during the present cent -.try, the prevalence and 



46 HISTORY OF THE CHOLERA. 

fatality of epidemics have greatly diminished ; and 
from what has already been accomplished, we are 
satisfied that, by adopting proper social, moral, and 
sanitary reforms, the value of human life can be won- 
derfully enhanced. 



THE CHOLERA FROM 1817. 

From the year 1817, the character of the cholera 
has been so well defined, and its wanderings in search 
of victims have been so clearly traced, that no ques- 
tion has arisen as to its visitations or results. 

By the end of 1818, its ravages embraced nearly 
all of Hindostan. It prevailed within the limits of 
the Himalaya Mountains on the north, Cape Cor- 
moran on the south, Bombay on the west, and Sylhet 
on the east. In 1819, it appeared in Arracan, Peran, 
Java, and in the Isles of France and Bourbon, and 
over the whole of the Indo-Chinese Peninsula. The 
year 1820 found it in Siam, Malacca, the Philippine 
Isles, the southern provinces of China and Guzzeret 
in India, and Tiberius in Judea. It visited Muscat in 
1821, Bagdad in Arabia, various parts of Persia, the 
Bahrian Island, and Borneo. During the winter of 
this year, it declined in Persia and Syria ; but in the 
spring of 1822, again made its appearance, and 
ravaged almost every town and city of Persia. 

In 1823, it broke out at Antioch, Tripoli, and all 
over the extent of the Mediterranean coast, the Spice 
Islands, and New Holland. It extended its dominions 
over the towns of the Caspian Sea, and the same 
year made its appearance in the city of Astracan, 



THE CHOLERA FROM 1817. 47 

near the mouth of the Volga. From 1823 to 1827, 
the disease continued its ravages throughout China, 
India, and in 1826 nearly depopulated several cities 
in Mongolia, traveling as far north as Siberia. 

In 1828, the Russian empire was again invaded. 
The cold of the succeeding winter stayed its progress 
somewhat, but the summer of 1829 found it com- 
mitting fearful havoc in the same localities. In 
1830, it appeared in the Georgian cities, and again 
in Astracan and along the course of the Volga. It 
traveled into Poland this year, visiting its principal 
cities. From thence, along the borders of Prussia 
to Odessa, and to the White Sea. In the middle of 
September of the same year, it appeared in Moscow. 
In 1831, Warsaw, Riga, Archangel, St. Petersburg, 
Cronstadt, Dantzic, in Prussia, Brody and Lemburg, 
in Austria, Berlin, Vienna, fourteen towns in Hun- 
gary, Hamburg, and other places, in the kingdom 
of Hanover, were ravaged by the pestilence ; and, in 
the month of August, it made its appearance in Sun- 
derland, England. In December, it reached New 
Castle and Gates End. At about the same time, it 
appeared in different places in Scotland. London 
and Dublin were visited by the cholera in March, 
1832. During the month of May, it prevailed, to 
a fearful extent, in Paris, and continued its devasta- 
tions during the remainder of the year. 

Its first appearance in the New World was at 
Montreal and Quebec, in the month of June, 1832. 
During its prevalence, the mortality from the disease 
was great. 

The cholera appeared in New York, also, in June, 



4? HISTORY OF THE CHOLERA. 

1832 ; in July, of the same in Philadelphia. 

Baltimore was invaded in August, and subsequently 
the epidemic reached many of the principal towns 
and cities in the Unit- States, -reading conster- 
nation and dismay in every direction. 

Since the year 1832, although occasional i of 

cholera have heen reported in different localities, no 
visitation of the d:~ ? took the form of an epi- 
demic until 1849, when rumors of the scourge were 
again heard afar off. From Asia came the first note 
of alarm, as before. Over the same highways and 
s its march was heralded, and with the recol- 
lection of its former hideous aspect, no wonder the 
people awaited its approach with fear and trembling. 

He history of the epidemic of 1849, 1850, and 
1851 is nearly a repetition of the event3 connected 
with the invasion of the disease in 1832. Its course 
was ~rry nearly the same. It presented the same 
frightful and chilling appearance, and was equally 
as fetal, among the imprudent, the intemperate, the 
debauched, the uncleanly and filthy, as on its first 
appearance. Medical men had, however, profited 
by the experience of the past; had learned some- 
thing of the characteristics of the disease, and, from 
observation and experience, were enabled to collect 
it amount of valuable knowledge on this most 
important subject. Their suggestions for precau- 
tionary measures, generally and individually, we 
believe, did much to lessen the mortality. Reflect- 
ing citizens were not taken by surprise, and were 
better prepared to encounter the destroyer. In this 
respect, the latter visitation of the cholera mate- 



TEE CHOLERA FROM 1817. 49 

Hy differed from that of 1832; and with the ex- 
perience of the two visitations before us, we honestly 
believe that, should the cholera again appear in our 
midst, by publicly and individually adopting such 
mea- - of precaution as the lessons of the past 
have taught us are necessary to shield a^ains: its 
attacks, the mortality will be comparatively small. 
It will, in fact, appear only as a mild and easily- 
managed disease when taken in its early stage-. 



PART IV. 



■^XKc 



CAUSES OF CHOLERA. 



'•"Where are your stores, ye powerful beings — say, 
"Where your aerial magazines reserved 
To swell the brooding terrors '?" 

"We know that climate, local circumstances, and 
the moral and social condition of the people, pro- 
duce individual symptoms, but no definite conclu- 
sion can he reached as to the remote, the original 
cause of cholera. We study the peculiarities of epi- 
demics, follow them in their erratic wanderings over 
the habitable Qflobe, see them suddenlv taking their 
departure from localities apparently congenial, and 
unexpectedly appearing where least looked for — 
again pausing in their fury, in the midst of their 
work of carnage and death, as if to gather renewed 
strength, and then breaking out at some point of 
their former track — we are bewildered at their inex- 
plicable mode of journeying, and the attempt to ac- 
count for their mysterious movements only serves to 
perplex and confuse our minds. It is quite imj :~ 
sible to give any explanation as to the original cause 
of cholera. TTe know enough, however, to convince 
(50) 



CAUSES OF CHOLERA. 51 

us that its remote cause is a subtle, poisonous, 
atmospheric influence, operating, probably, either 
upon the nervous system, thus affecting the organs 
of sensation and sympathy, and through them caus- 
ing a depression of all the vital powers, or a specific 
poison acting directly upon the vital functions 
through the medium of the blood. In either case, 
the progress of the disease is so rapid that all the 
powers of life appear to be at once acted upon and 
extinguished. But while the original influence may 
invade the system and produce the "premonitory 
symptoms," such as looseness of the bowels and de- 
pression of the natural powers generally, the posi- 
tive and fatal form of the disease is dependent for 
its destructive powers on a combination of the 
original with local causes. Derangement of the 
organs of digestion, no doubt, becomes an exciting 
cause. The atmospheric cause may of itself produce 
derangement of the digestive organs, and when a 
combination of causes act in concert, the disease 
hastens rapidly and surely to its final and fatal ter- 
mination. 

It may be laid down as a rule, that any disturb- 
ance of the mental or physical functions will be 
likely to affect the natural operations of the system, 
and lead to an attack of an epidemic disease during 
its prevalence. At another time, indiscretion in 
eating and drinking, over-exertion, sudden check- 
ing of perspiration, or excessive mental excitement, 
may produce entirely different effects. Cholera- 
morbus, rheumatism, headache may result ; but 
when the cholera poison pervades the atmosphere, 



52 HISTORY OF THE CHOLERA. 

these and other proximate causes, comparatively 
harmless during an ordinary state of the atmosphere, 
would act as a positive cause of cholera. This is an 
important consideration in the rules to he adopted 
for the prevention of the disease. The statement 
can scarcely he controverted, that epidemics are de- 
pendent for their destructive powers on local causes. 
They will fasten with peculiar severity, and hold on 
the longest in localities that have been neglected, 
and local diseases growing out of a lack of cleanli- 
ness, or proper sanitary precautions, are often the 
parent stock upon which epidemics like the cholera 
are engrafted and flourish. TTe have no plagues 
now to carry off a hundred thousand persons in 
four months, as did the Black Death in London ; 
and simply because the tilth, want, and miserv that 

J- v 9 9 «/ 

prevailed in the cities of the world during the Mid- 
dle Ages, have been, in a great measure, removed. 
To this we owe our comparative exemption. 

The mortality in London during the latter part 
of the sixteenth century averaged one-fourth part 
of the population, or what with its present number 
oi inhabitants would amount to 375,000 deaths every 
year. During the cholera of 1832 — the worst plague 
that has visited London since 1666 — the deaths were 
only one out of 250 inhabitants. This decrease in 
fatality was due altogether to the improvements that 
had been made in regard to cleanliness. 

What doubt there may be as to the nature of the 
cholera poison, there appears to be but little as to 
the point from which it emanates. 

In the history of the cholera, it was stated that its 



CAUSES OF CHOLERA. 53 

origin, in several instances, was traced to the pil- 
grims who visited the banks of the Ganges, in the 
observance of their religious rites. The present 
visitation of the pestilence appears to have had its 
origin in the same cause, as will be seen by a late 
report compiled for the Egyptian Government. 

The havoc committed by the epidemic at Alexan- 
dria suggested official inquiries, and the President 
of the Board of Health addressed a communication 
on the subject to the Minister of Foreign Affairs, 
which deserves consideration. In this paper it is 
stated, as the opinion not only of the President him- 
self, but of all the scientific and professional author- 
ities in Egypt, that the poison is generated in the 
crowds of pilgrims periodically visiting the holy 
places of Arabia. Even the first origin of the dis- 
ease is ascribed to the same source; and, whatever 
may be our view of the theory, it is impossible, after 
perusing a narrative of the facts, to deny the prob- 
ability of the inference. The pilgrims congregate at 
certain periods of the year, from all points of the 
Mohammedan world, to the number of seven hun- 
dred thousand or eight hundred thousand. They are 
not of a class naturally either careful or cleanly, and 
on these occasions they are worse than usual. It is 
even a point of religion with them that no pilgrim 
should change his clothes during the whole time of 
his pilgrimage. 

"Under these conditions, they are huddled to- 
gether in enormous crowds beneath the fiery sky of 
the desert. It is an indispensable incident of the 
ritual that each pilgrim should sacrifice at least one 



54 HISTORY OF THE CHOLERA. 

sheep, and the skins and offal of th 
victims are left to decompose under an Arabian 
snn. The result of all this is. that thousands of pil- 
^s perish on the spot, leaving their bodies to be 
shuffled hastily und : a coating of sand, which the 
first sirocco will d:v ase, and their clothes to be 
packed up and carried off. as ss red relics, to be 
distril ited among their relatives and countrymen. 
The Egyptian Minister thinks that here is the 
seed-plot and hot-bed of cholera, and there fa 
tainly nothing improbable in the conclusion. He 
wishes, too, that the European powers would take 
into their serious consideration a practice which is 
obviously beyond the power of a Mohammedan 
Government to control.' 7 

TLe accounts from Constantinople, during the 
autumn of 1865, were of the most appalling charac- 
ter. The cholera, pursuing its oe ial course, had 
reached that place, an 1 signs of panic were ob- 
served on every hand. u The spirit of fear con- 

tI.- the spirit of Mammon. The bazaars were 
closed. Business was nearly at a stand-still, and the 
merchants shut themselves up in their country seats. 
You saw women, unable t: resist the fascination of 
. looking eagerly out of their windows: and pe- 
destrianfi shrinking back, and putting their hand- 
le: "chiefs to their noses, as the coffins passed by. 
Bodies of those scarcely dead were thrust into cof- 
fins, and hastily hurried off for burial. You call at 
a shop; the master, or one of his hands, is groan- 
ing in bed. You go to visit a friend; he has just 
been buried. Processions of overworked priests fill 



7515 :r :h:iz?.a. 

the - and pray for the cessation of the pesti- 

lence, hundred, at least, died at Stambonl 

in one day. 

The course pnrsned by the Turkish Government 
appears to have been but a repetition of the absurd- 
ities of the Middle Ages. The Sultan gave orders 
that all classes should make merry. So, bad bra:: 



:-;.ki. ;.n.i Turkish mns:; ~e: 


t the ; riers :: the .:;.y. 


- - _ 


:: .:.'..? :a trying the 


\ie:..h :he streets resmnael vr 


.th ni:n:::n:vs :~-\nm- 


ings, drunken routs and bow] 


::m. The weather ~;;5 


almost unbearable, the sun 


red hot. The wind 


' _..: :.; ithe: :: esLness. n 


:r the night : : : . x e 5 - . 


In the sun the glass stood at o 


:: httnirei and thhty- 


thfee ie^tees. unl ::: the ::: 


.est ihioes ntnety-ehrh! 


decrees. Oir :h:::s.\nh liei 


Tvhv. A -■;■;._: ;? r;en- 


tleman residing there says : 


TT J 


s:. ; l^-'t ^strin^ent iie: ;-.s :. 


* MMi p ry measure 


of safety, I went to make 1 


e . - . ^ ~ r t e rs . :: c n .: 7 


;::st iiei in the h;::se. I ::: 


shei ::tt;-t : ; ;.■_ ?:her. 


There were three dead tbere. 


C ;nn: I ;. :k. I me: 


the ie;. i-tart - hth :.: leas: : 


ee "nnnirei :; : i: T ; :n- 


sine. Six nieihtal men h:.Te 


s::::::m .:>e.. :: me 1:5- 


e:.se. 




Ints wis in the mil of 18C 


C ' " *-— "" J3 " 1 


men died is not to be won . e 


- '_ :: , Trhen ~- '-: 


that the Turkish doctors stD 


.„ . C I C - T - T-_ . _ .1 


" : :.:.".: : er t.^.v.nst :; t.thinr. 


■* _ .^_tr* ^.., ^ . » 


and persistent, object to. I 


ne : ; rres: : ■_ ien: :':::*- 


ther says: u Ae :: myself I 


um 75 ~eh as ::s::;h. 


I eat in moderat: n. and 


he in iemmte :: :he 


dcc::T5." Ho~ like the h:r 


:hhe scenes rektei :■: 






>t _-_:: 11 lit ; .LriT :•:' 



_ : --. :i : : 



: 



" _ - • - 



~ ..- 1 Z 



SbtIhrthI. Qm. tffce sanra Ai. 



:■: . 



: -■ -; 



1- i 



: - 11 - :••= : : — ~. i-: 11." i_ - rijjr:^.: 






_1 L ; "'-' if 



.:.- 



L" ~ - :'.-..:_ ^ 



.- 



iu ".i-l 



H i '.I f 



t _.- _ 7 -c : i_._" :~ 



: • n.: lZ: 



: i_. 



CONTAGION. 1 

matter of speculation, and. consequently, to the gen- 
eral reader, devoid of interest or profit. The great 
fact, however, is well established, that a malarious 
sod does exist; that, combined with local causes. 
it operates with deadly power. By imprudence in 
living, fatigue, want of sleep, gorging the stom- 
ach with food, stimulating the brain with alcoholic 
drinks, savins: wav to fear, or. in fact, anv irrem- 
larity having a tendency to derange the course of 
nature, the magazine is prepared with explosive 
material, only waiting the epidemic match to hurl 
its victims to destruction. Before I close this sub- 
ject. I wish to impress upon the minds of all the 
necessit being calm and collected in the event 

of the approach of cholera. Fear is a mental poison, 
and with the mysterious principle of evil that is 
wafted with the breeze and rides on the whirl- 
wind, it has a deadlv arrinitv. 



005TAGI03T. 

'• Obscure :h.e seeis f.ue dies unLeeiei sow. 
Of slight beginning?, to such fearful ends.'" 

The discussion among medical men as to the con- 
tagious or non-contagious character of the cholera, 
has been earnest and thorough, but by no means 
satisfactory. The majority 01 the profession, how- 
ever, reject the idea of its being contagious. 

During the epidemic of 1849 and 1850, my obser- 
vations of the disease, in St. Louis, gave me an 
opportunity to form an opinion on this subject under- 
standing^. After the pestilence subsided, I gave it 



55 HISTORY OF THE CHOLI. 

much thought and investigation, comparing my own 
experience with the facts which came to my knowl- 
edge from other sources ; and while occasional cir- 
cumstance- ared, at a superficial glance, to con- 
firm the opinions to the contrary held by many 
y eminent medical gentlemen, nothing presented 
itself to my mind which, on due investigation, 
convinced me of the contagious character of the 
cholera. Cases occurred, now and then, which gave 
the advocate of the contagion theory plausible 
ground for argument; but, after all the circum- 
stances were brought to light, not one instance of 
unequivocal contagion could be cited. 

On the first irruption of the epidemic in St. Louis, 
a small steamboat was taken to Quarantine Island, 
a few miles below the city, and used for hospital 
• ::~es. Being found too small to answer the 
requirements of the case, after a short time she was 
replaced by a larger boat. Having been taken to 
the shore of "Bloody Island," opposite the city, 
and thoroughly fumigated, she there remained for 
a considerable length of time, an object of dread 
and fear to all who saw her. At length her owners 
succeeded in chartering her for a trip up the Illi- 
nois Elver, for the purpose of transporting a body 

of United States soldiers, on their TTest. 

> 

Shortlv after she left the landinsr, the rumor was 
put in circulation that the boat had but re- 
cently been used for a cholera hospital. The s - 
diem became panic-stricken, and in the midst of the 
fearful -:ene of excitement that ensued, the cholera 
broke out in its most malignant and fatal form. 



ysu i wr. 

The officers participated in the general alarm; the 
boa* ran to the shore, made fast, and deserted 

by every person who conld leave it. The affrighted 
crowd scattered in all directions, making their 
cape as best they conld, mostly in the direction of 
Many of the crew and soldiers, and 
ral of the officers of the boat, were after- 
ward fonnd dead in the woods, having fallen while 
attempting to save themselves by flight. It was 
reported that twenty-two bodies were fonnd on 
board. 

How mnch is there in the facts connected with 
this case to snstain the theory of contagion 3 I can 
see none whatever. Y^:. it was ::ted as evidence 
in support of the opinion, it being maintained that 
the sndden irruption of cholera was caused by infec- 
tion from the boat. Is it not clear that the nervous 
excitement, caused by the rumors put in circulation 
among: the crowd of soldiers that the boat had been 
a cholera hospital, was a powerful exciting cause? 
Et is also probable that the soldiers were no: w 
cleanly and temperate in their habits m vras re- 
quired for protection against the disease. These 
local causes, brought into active operation by fear 
acting in unison with atmospheric influences, un- 
questionably induced the attack. 

Other instances occured which migbt appear to 
show the contagious nature of cholera; but, upon 
due consideration, it may be fairly concluded that, 
like the case noticed, there was a local, exciting 
:•£'.;= e. 

During the autumn of 1859, a large steamboat, on 
6 



M TORY OF THE CHOLERA. 

her passage up the river from Xew Orleans for B 
Louis, was vded with German emigrants, 

as deck passe _ The trip progressed favorably 

until their arrival at Cairo, at which place a quan- 
>f castor-oil beans, in sacks, were taken on board. 
The deck pas- s, under the impression that the 

beans would be a valuable acquisition to their scanty 
store of provisions, appropriated a portion to their 
own use. Having cooked and eaten of them, I 
were attacked with sudden and severe purging. 
Bt'i: rr_:::-r-7 mmmm: :: :m mm:m :: :*m mm- 
table of which they had partaken, they were natu- 
mIm m.;m :mmm! :.: :"mst m:".m: s;m:m:ms. m! 
the only idea that suggested itself as the cause of 
their sickness was the cholera. The panic spread 
::;n :Lt Im^ .•: :'_r :mm. ;._ 1 :m res;": m.s :'_;.: 
^1-rr- :1c :m: ;m:m! :.: :m m:m:;m s.mIm Me 
.1:':... "ii mmm mi Mi" Me psiri^r: in Mr 
cabin and on the deck, and quite a number fell ~ - - 
:im.= :•: :m- iisee.se. Tie iie: :: ."..::: is ;_:;- 
mm; :m :tm m '." i mm ::. m m m : se m : mm 
been most familiar with cholera will scarcely enter- 
mm ::, 

Tie ::m::I m mm lives: Mei: immIs :: :.'! :::::::: 
:: iMrs :: :m:.mmm. m :ms is mm sM~e:v m! 
eiM::::: les: se:M~el. Im m : ^i;m:-::m ;: mm 
:. :Lt../ m"- :: m;m :m mm m:~. lmjmm 

As m eviler_:e :: :m- ::_■::_::.:::: :_mm: 
;: :i:^:;. iMsiieMM :ir mms:o7_:-s :mmmmmm 
i:s Mv^im ;: Me 2m — ~m:m. I: ~rs: r_Mie i:i 
mm:mm; in M:::m'.. m! 1:1 m: mm — ;m ::r 
Mr mm". iM-ies :: :;iT-Tii;i — :: T mm mmmIs 



ELECTRICITY. :1 

^vhieh, it contagious, it could be carried — but it 

traveled with greater rapidity, and distant cities and 

re vis::; thin a few hours, or, at most, 

days, of each other. It traveled, like the genii of 

evil, with the speed of the wind, and as erratic in 

If cholera is contagious why did it not come to 
country, in l v :_. ^dth the messengers that 
brought the news of its ex s:rnce in European po: "fa 
How did it get here in advance of these messenflr-r _ 
In what way was it communicated to ships in mid- 
ocean which had left healthy ports ! Such was the 
case, and, in one instance, nearly one-half of the 

■ssengc b and crew died. Having appeared in New 
York, how was it taken to our Western towns and 
cities before any other conveyance could reach them ! 

The reader can consider these queries in his own 
mind, and, in doing so, he will scarcely fell to see 
the impossibility of cholera being communicated y 



mrTiirm 



Z.ectrichy has been suggested as a cause of the 
cholera. This subtle power is known to pervade all 
creation. Space and organic matter, alike, are under 
its influences; but what can have given rise to the 
idea that it is the cause of malignant disease, ~r 
are at a loss to conceive. It may be intimately con- 
nected, in some mysterious way, with the disorders 
with which human:: ifi afflicted, but with us much 
reason mav we dieve it to be the original cause of 



zis: ' : . : _• tzt 



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W I 






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: 7 : • _ t : : 
:-.t :ir. .".: _ 






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■item. The 



if \ - ..~-±z> izz::t . : 

— It- z?:z*-*i *:~ i ~. \-l- r.zrzz. i:i 

' . - : _ . v : . ... v . . .1:1 . - 
-It; - . . •"- ' _ ... .*""-- 

:i~: ,- : . _ _-- :_ 11 7 . : .- 

: 7 ~ . ~ ; : ' 7 : - 



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. 1 "_t LLZ . . 11 t 11111 11_ 

. ..- ... _~ = llilll : 1111 i_ . ri 11 f rjn-rl 

_- -. . _ 7: — "_i:i .._--.- - 
:r~- 1-7 e-7i_i 1:11.5 ;: 7:: !_.- 11- 1 



1. 

a 1 



64 HISTORY OF THE CHOLERA. 

to detect its presence in any positive form, but judge 
of its existence by a long series of analogous effects. 

We have, as yet, so little to direct us, so far bub 
a positive solution of this question is concerned, that 
it must remain undetermined whether the primary 
cause is disseminated through the nerves or some 
other organs. If the brain and nerves are con- 
cerned. it can onlv be as a medium to transmit the 
impression made on them, by the poisono o - E> nt, 
to the other parts of the system. The nerves them- 
selves can not be affected, for it is a noticeable fact 
that, in eases :i cholera, * ; the mind sits unimpaired 
and serene amid the ruins of organic life." Breath- 
ing is only performed as if by a muscular effort. The 
pulse ceases to throb; even the beating of the heart 
can not be detected, and yet the mind is active and 
vigorous, and calmly contemplates the wreck of its 
mortal tenement. The functions of the brain ap- 
pear to be undisturbed, while the heart, the lungs, 
and organs of life, are involved in a chaos of disor- 
dered action. T\~ell-authenticated reports have been 
made :: sases in which the sufferers lived two. thrc-. 
and even four days after the pulse had ceased to beat. 
I have seen one — that of a strong, robust man, 38 
vears of asre — who was attacked on the morning of 
the 10th of June, 1851. The same night, about 12 
o'clock, pulsation at the wrist ceased, and he re- 
mained in this condition sixty-four hours. During 
this time, although his voice was strangely hoarse, 
he conversed freely and intelligibly until within a 
few minutes of his death. 

The patient is generally acutely sensible of ex- 



ANIMALCULAR THEORY. 65 

ternal application, and expresses a consciousness of 
pain on the application of heat to the cold and ap- 
parently lifeless limbs. He is aware of all that takes 
place in his presence. In fact, the operations of the 
nervous system are continued to the very last mo- 
ment of life. 

I may have digressed somewhat occasionally, and 
repetitions have also occurred, but the reader, I trust, 
will excuse me. My aim is to present the subject 
in its various phases, and, in a familiar way, to re- 
duce the matter to as comprehensible a form as pos- 
sible, and, in doing this, I may sometimes make note 
of a fact or allusion to an idea that has been pre- 
viously advanced. I ask a little indulgence in this 
respect. In seeking for the cause of cholera, let us 
not deceive ourselves with any theories or opinions, 
however plausible they may appear. We see elec- 
tricity operating through space, pervading all organic 
matter, yet we can not comprehend its nature. The 
mystic power that spreads disease and death in the 
form of cholera is alike beyond our conception. It 
moves here, there, every- where; seemingly a mala- 
rious, ubiquitous fiend. It is vain for us to attempt to 
flee from it, and equally vain to bar its progress by 
quarantine regulations. It is in the air we breathe. 
It has unbounded range over the face of the earth, 
and as well may we attempt to stay the lightning's 
flash as to arrest the cause of cholera. It is not a 
thing to handle, to cage, to put aside, but a malicious, 
malignant principle. 

But, although the cause of cholera is subtle, in- 
tangible, and beyond our reach, it has its laws ; and 



HISTORY OF IHE CHOLERA. 

we have been taught, by the experience of the r 
that one of its laws is to manifest itself wherever 

:ilential miasmata invite or mental infection pre- 
vails. Our duty, then, is plain. Act on the m si 

; onable sanitary suggestions presented for y 
consideration. Be governed by the -hall 

hereafter give in regard to eating and drinking. Be 
calm, and, without fear, do your duty toward each 
other when called on to render assistance to the 
afflicted. •• Do unto others ; a y m would have others 
do unto vou." Xever be deterred from doing- kind 
offices for the sick by fear of contagion. Eemember, 
when the victim is first stricken down every moment 
is precious. A life depends upon your aid at the 
proper moment. Purify the physical and moral 
atmosphere in which you move, and, depend v 
it. the cholera will be disarmed of its most deadly 
weapons. 



PART IV. 



:>>**< 



SYMPTOMS OF CHOLERA. 



u I run the gauntlet of a file of doubts, 
Each one of which down hurls me to the ground.'' 

Unlike almost every other epidemic disease, the 
premonitory symptoms of cholera are variable and 
uncertain. It has been a noticeable fact, however, 
that diarrhea and other complaints of the bowels 
have very generally preceded a visitation of the 
cholera; but as there are times and seasons when this 
laxity of the bowels prevails quite extensively with- 
out being followed by the epidemic cholera, we are 
very liable to be indifferent to the admonition, until 
too late to ward off the more serious malady. Diar- 
hear, sickness of the stomach, a general feeling of 
lassitude, is a condition of the body which, in times 
of anticipated attack from cholera, should not be 
overlooked. 

The cholera, in three cases out of four, makes its 
attack at night and in the early part of the day. I 
mean by this the malignant symptoms. The pre- 
monitory indications may have existed for days 
unheeded, and the victim retires to rest unconscious 
of the lurking devil within him. Suddenly he is 
7 (67) ' 



65 ::: story op the cholera. 

kened with a sense of nausea, oppression, or a 
feeling of emptiness of the stomach, followed almost 
immediately by a desire to evacuate the bow 
chi 1 /. - i -ation creeps over the whole b: : niiting 

and purging now set in. If the patient has been for 
some days troubled with a diarrhea, or loose: saa : 
the bowels, the discharges will have the appearance 
of rice-water, with a small amount of loose, mi: 
like matter, which soon falls to the bottom of the 
vessel, saving the fluid thin, resembling slightly dis- 
colored water. If no premonitory diarrhea has oc- 
curred, the first discharges will be filled with the 

I matter of the bowels : this having been evacu- 
a ted, t fa e wat b - : h a rgee will immediately follow. 

The matter vomited from the stomach will be, first, 
what remains of indigested food. This having been 
thrown off. the subsequent appearances are the same 
:, ; that evacuated from the bowels. These opera- 
tions from the stomach and intestines are not always 
accompanied with pain or distress, though frequently 
in a slight degree ; but very often there is experienced 
only the prostrating effect resulting from vomiting. 
The next symptom will be intense thirst, continually 
increasing and torturing' the patient as the disease 
a 1 aneea A general languor and listles mess, eh 
teristie of indifference, will succeed. The pulse in- 
creases in frequency, but becomes more and more 
feeble, and may, at this or any subsequent stage of 
the disease, sease : beat altogether. The skin loses 
its natural warmth: the nose and ears become cold. 
The patient will be sensible of a stiffness of the 
joints. He is disposed to rest, and desires to be 



SYMPTOMS OF CHOLERA. 69 

undisturbed. Sometimes he speaks of a slight dizzi- 
ness and a ringing in his ears. About this time, 
the muscles over the abdomen are found to be hard 
and contracted, in some cases; in others, the belly 
remains soft and natural. The feet and toes now 
begin to contract spasmodically ; sometimes the hands 
and fingers are affected, and occasionally spasms are 
noticed in the muscles of the body. If the pulse 
has not already ceased, it will gradually become 
smaller and quicker. 

Perspiration breaks out freely, profusely increased 
by every effort to vomit. The body becomes colder, 
and imparts no sensation of warmth to the touch. 
The sufferer is restless, and continually moves and 
throws himself about. The skin around the fingers 
and hands shrinks, and is drawn into ridges; and 
the same appearance is frequently observed on the 
feet and toes. This gives the patient the appear- 
ance of great emaciation. From this cause, I have 
seen a ring fall from the finger, which had been worn 
for years, and that could not before be removed. The 
countenance changes from its indifferent to an anx- 
ious appearance, and at this stage indicates pain and 
suffering. The features are shrunken and contracted ; 
the eye sinks into its socket; the nose is pinched. 
Pain in the abdomen is evident. Breathing be- 
comes labored and difficult, and is accompanied with 
a sigh or murmur. The skin changes to the color 
of lead. The patient will complain if heat or stim- 
ulating applications are applied to the skin, although 
the entire body will be as cold as marble; and yet, 
though acutely sensible to the application of heat 



- 



7 1 j 7 "-" 'T ~~± • 







:_- - 



- ji - 



"L~z 



ri~ 



- '- ' - 




SYMPTOMS :t cholera. 71 

can be done. If. however, they were susceptible 
to the action of remedies, the alarming symptoms 
would abate simultaneously. The pulse would rise, 
the features expand, purging and vomiting ::..-■:-: a 
warm glow would spread over the system, the urine 
_in to now, and some.: - the tongue, which may 
have been thickly coated, will, in a very short time, 
-/.me a clean and healthy appearance. In other 
- :he fur on the tongue ill increase, and the 
:ns will slowly and almost imrr re eptibly re- 
sume their natural now. "With such patients, no 
time is to be wasted. \ V hatever is tc be lone must 
be done quickly; and if a recovery is to be effected, 
the returning state of health must be carefullv 
~:.: 7_r :- : ivery will be slow, and the slight- 

est indiscretion will bring on a relapse, in which 
event death is next :: certain. 

Where there is a total absence of premonitory 
diarrhea, such cases are exceptions to the general 
course of the cholera, We do not. however, com 
sidei the diarrhea as one of Hie stages : the :liol- 
: but, from the peculiar condition of the choleric 
atmosphere, or from some other hidden cause oper- 
ating at this time, looseness of the bowels prevails 
ex:ensively, and is found to precede the malignant 
disease. Diarrhea mav became an exciting sansa 
The discharges from the bowels during this prelim- 
inary diarrhea are oi an entirely different nature 
from those of cholera : thev are thin and watery, 
as is the case in looseness of the bowels at any other 
time: but there is a discoloration, indicating the 
presence of bile. In cholera the bile ceases to now. 



72 HISTORY OF THE CHOLERA. 

This is a distinguishing feature of the disease. 
u Premonitory diarrhea*' is the result, sometimes, of 
atmospheric influences, brought into action by local 
causes. It may. if neglected, become an exciting 
cause ol cholera. Abstinence and mild treatment, at 
the proper time, will enable nature to effect au 
escape from the more terrible disease : but if neg- 
lected for a day, or even an hour, it is converted 
into a perilous malady, which, though but for a mo- 
ment in a state of incubation, will baffle the efforts 
of nature and art to subdue. 

During the prevalence of cholera the operations 
of the bowels should be carefully watched. Diar- 
rhea will yield to remedies ; cholera, seldom. Diar- 
rhea may become the exciting cause of cholera. 
Xever allow it to run into the malignant disease. 



ESPECIAL FEATURES OF CHOLERA. 

The peculiarities heretofore mentioned may not 
be usuallv found in individual cases, but will be 
observed in the general run of the epidemic. One 
case may be distinguished by the absence of vomit- 
ing: another by the absence of purging. Spasms 
may not always occur, and sometimes all of these 
symptoms may be wanting, the disease being ush- 
ered in with a deathly coldness, a suspension of cir- 
culation, very slight commotion of the functions, 
the patient passing away with scarce a struggle. 
It is a fatal form of the disease, fortunately exceed- 
ingly rare. 



PURGING — VOMZEEHG. 73 



PUBGDrOi 

This symptom is seldom absent altogether. It is 

_ erally the first indication of an approaching at- 

k of malignant cholera. It is not always, how- 

ever, the first symptom that attracts onr attention, 
se it ifi liable to be mistaken for an ordinary 
call of nature: whereas, vomiting is at once notice- 
able as a departure from health. In cases where 
little or no purging has taken place, the attack has 
been peculiarly malignant. The evacuations are 
sometimes made without effort, the contents of the 

r ela passing off almost unconsciouslv. Asrain 
the discharge takes place with great force. Some- 
times purging, vomiting, and spasms occur simulta- 
neously, as if each originated from the same cause. 
Ordinarily, the calls are sudden and irresisti":--. 

:mpanied only with slight pain in the abdomen. 
In the advanced stage of cholera the bowels are 
often relieved unconsciouslv. the waterv fluid pass- 
ing from the body on the least movement or change 
of position. The matter evacuated is usually in- 
: i;rous and colorless. It is. however, sometimes ■::' 
a frothy appearance, but invariably free from the 
slightest trace of bile. The reappearance of bile in 
the stools is a favorable indication, as this does :::: 
occur until the disease has Veen subdued. The 
amount of watery fluid evacuated is no evidence of 
the fatality of the case. In some instances, where 
the discharge has been enormous, patients have re- 
covered, and in others they have died after a very 
slight evacuation. 



74 HISTORY OF THE CHOLERA. 

This fact should be borne in mind. Many an at- 
tack of cholera has occurred, and many lives have 
been lost, by not attending promptly to the first in- 
dications of purging. Whenever a looseness of the 
bowels occurs, be on your guard. Whenever the first 
watery discharges are observable, be prepared to 
check the advance of the insidious destroyer, or im- 
mediately apply for medical aid. 

VOMITING. 

Vomiting is one of the most prominent symp- 
toms of cholera. In few instances is it altogether 
absent; yet such cases do occur. Immense quanti- 
ties of watery fluid pass from the stomach, differing 
but little, after the first contents are discharged, from 
the evacuations from the bowels. Sometimes the 
stomach appears to be in a lifeless, sluggish condi- 
tion, incapable of throwing off" its contents, and 
there is a painful straining to vomit. Fluids swal- 
lowed are thrown off, as if by a spasmodic effort of 
the passage, before reaching the stomach. At other 
times, the stomach appears to retain whatever is 
poured into it, as if it were an India-rubber sack. 
This is a most alarming symptom, and indicates, 
almost surely, a fatal termination. 

Sometimes, at the beginning of an attack, bilious 
matter is vomited. This is only what may be in 
the stomach at the time. The watery ejections 
then follow, and the appearance of bile is a favor- 
able indication. 



SPASMS. 75 



INTERNAL HEAT AND THIRST. 

This, like the symptoms already alluded to, is 
sometimes wanting. It is generally observable, how- 
ever, after the vomiting and purging have continued 
a short time, and from its first appearance to the death 
of the patient it becomes more intense and aggra- 
vating each moment. While the sufferer is tortured 
with this insatiate thirst, while there is an agonizing 
burning heat within, the mouth and tongue are cool 
and moist. Rarely, indeed, is the mouth or tongue 
parched or dry. This thirst is ungovernable, and even 
with the belief that to assuage it with cold water will 
be death, the poor victim will eagerly drink, if within 
his reach. There is no symptom that more clearly 
shows a general constitutional derangement than this 
failure of the natural heat of the system. It is one of 
the first symptoms, and exists in every part, except im- 
mediately over the pit of the stomach and the region 
of the liver, where heat is maintained to the last 
moment, and after all the other organs of secretion 
are involved in disease. 

SPASMS. 

The contraction of the muscles of voluntary mo- 
tion is what is meant by spasms in a case of cholera. 
This symptom is also often wanting. 

The muscles generally affected are those of the 
toes, feet, and calves of the leg?, and the thighs, 
arms, hands, and fingers; sometimes, also, those of 
the belly and chest. These last are the cause of 



i b tense :.y :f the choli: 

great listress. Hiccup is sometimes an accompani- 
ment, but is not considered an indication of danger. 

The m iscles : the belly are sometimes drawn vio- 
lently in toward the spine. Spasms are invariably 
attended with pain. After recovery, the : itehiug of 
the muscles have been noticed several days, and this 
spasmodic action has continued for some time after 

:u:h. Spasms : eeur most frequently in the rob 
subject; also the intemperate. Males are affected 
more than females: children seldom. The fingers 
and toes are distorte:! in e~ery direction, and the 
limbs thrown about with s^reat violence. During 
tUrSr spasmodic convulsions, the patient will often 
leave his bed and endeavor to walk, in the hope of 
obtaining relief. 

COLLAPSE. 

This is the characteristic syuoittuo of ehclera. It 
always presents itself, unless the measures adopted 
for the relief of the patient have ' een successful in 
warding it off. In that case, the progress of the 
disease has been interrupted, and the remedial meas- 
ures, if continued, vriii l r a:I to retcverv. Iu ah 
cases of genuine m ii_nant cholera a drainage of 
the system commences, through all the vessels and 
channels of the body, from the first moment of the 
attack, and the ehtect of this will be observed in the 
gradual diminishing of the natural heat of the sur- 
:. "..:-. ace :■ mi* anted by a shrinking and contracting 
of all the organic members. This symptom may be 
modified, in some degree, where the patient has 
been under the excitement oi spirituous liquors, or 



THE SKIN COUNTENANCE. 77 

other powerful stimulants at the time of attack, and 
in such cases inflammatory indications may be ob- 
served for a short time, but they will surely abate, 
and the patient will sink into a final condition of 
collapse. The pulse will sometimes continue quite 
strong for a few hours, but seldom is such the case. 
Even during the action of evacuating the bowels 
the reduction of its strength is sometimes very ap- 
parent. It generally continues to grow weaker and 
quicker as the disease advances. Most likely, on 
the occasion of an attack of vomiting or purging, 
it will cease to beat altogether. Sometimes, when the 
vomiting ceases, the pulse will return for a short time, 
but again disappears ; and in this pulseless condition, 
as we have already stated, the sutler er may live three 
and even four days. Rarely, however, does this as- 
phyxiated or pulseless condition continue beyond a 
few hours. 

THE SKIN. 

The exhaustion of the system, in consequence of 
this terrible drainage by vomiting and purging, does 
not appear to affect the pores of the skin, for, although 
the temperature gradually diminishes, the perspira- 
tion is often very profuse. A remarkable condition 
of the skin is invariably observable. While it loses 
none of its sensibility, it can not be affected by the 
most active irritants. Even boiling water fails to 
produce any observable effect upon the skin, while 
the poor tortured sufferer feels all the pangs he 
would from the same application in health. Yet 
the marble coldness remains, and, to all appearances, 
the flesh is but dead matter. 



78 HISTORY OP THE CHOLERA. 

The skin, though moist with perspiration, is cold, 
and imparts a death-like chilliness to the touch, and 
this coldness extends over the entire body, with the 
exception of the pit of the stomach, but not in the 
same degree in the region of the abdomen as in the 
extremities. If the skin of a patient, in a state of 
collapse, is pinched, it retains the indentation made 
for a considerable time ; the fingers and toes, and some- 
times the hands and feet, are corrugated, assuming 
the appearance of ridges or furrows. If the sweating 
is profuse, the fingers and toes are greatly reduced in 
size. 

The color of the skin usually changes to a leaden 
hue, generally extending over the entire surface. 
The hands, feet, and lips are of a deeper shade, with 
but little discoloration about the eyes. Sometimes 
the leaden or bluish color is distributed in patches 
over the body and face. In occasional cases there 
is no striking change of color, and sometimes the 
discoloration will appear and disappear. 

THE COUNTENANCE. 

In the collapsed stage of cholera, the countenance 
of the subject can not be mistaken. In most cases 
there occurs a shrinking of the features; the eyes 
sink into their sockets, and are generally dull or 
listless, unless roused by some remark or circumstance 
to attract attention. At other times, during the in- 
tervals of pain or spasms, the patient remains inani- 
mate, with the eyes fixed and motionless. 

The cheeks appear sunken, the nose sharp and 
pinched, the muscles of the eyelids are not convulsed, 



BREATHING RESTLESSNESS — THE VOICE. 79 

and there is scarcely any winking. The never-chang- 
ing eye is fixed, as if looking away into the depths 
of that unknown world to which the sufferer is 
speeding his way. 

BREATHING. 

In general there appears to be no difficulty or in- 
terruption to the respiration. A sense of oppression 
is sometimes observable, however, and the process 
goes on slowly. An instance is recorded where this 
action took place only seven times in a minute. 
Breathing is rarely attended with distress ; but there 
appears to be a labored effort occasionally to respire, 
and this will cause the patient to be restless and 
uneasy, turning and throwing the clothes from him. 
Fresh air affords relief, and gives the sufferer rest 
for a time. The remarkable coolness of the breath 
is a uniform symptom of the collapsed stage, and, in 
the later periods, comes from the lungs as if from 
an iceberg. 

RESTLESSNESS. 

This may be considered an unfavorable symptom, 
though not always present in fatal cases. Some- 
times the patient passes through all the changes of 
the disease with little disquietude, and death ap- 
proaches while apparently awaiting his embrace 
with complete tranquillity. Probably the restless- 
ness so frequently observable results from oppres- 
sion in the action of some particular organ. When 
the patient is quiet, and disposed to rest easy, it 
may be considered a favorable symptom, though by 
no means an indication of recovery. 



80 HISTORY OF THE CHOLERA. 



THE VOICE. 

The tone of the voice is ^enerallv unnatural, but 
not invariably so. Sometimes it is hollow, and 
reaches the ear as if cominsr through a lon^ tube. 
Sometimes it is feeble, and but a whisper. Again 
it may be hoarse, rough, and unnaturally strong. 
When the voice is strong, speaking appears to pro- 
duce no exhaustion. In some these is a decided in- 
clination to converse freely. 

THE TONGUE. 

The condition of the tongue is no positive indica- 
tion of the state of the patient. If there has been 
much diarrhea previous to the attack of cholera, the 
tongue will probably be a dirty white in the center, 
and clean at the ed^es. The state of the tongue 
during the preceding diarrhea will be so variously 
modified in the attack of cholera, that little reliance 
can be placed upon it. Those who have observed 
the condition of this organ the closest, consider an 
approach to the natural state unfavorable, and a thick 
coating an encouraging symptom. Accumulations 
of dark, foul matter about the teeth are the fore- 
runners of death. The most uniform indication in 
connection with the tongue is the gradual reduc- 
tion of heat. The tongue will remain moist, the 
temperature decrease, while the patient begs for 
water to allay his thirst. 

THE TRIXE. 

The flow of urine is, from the commencement of 
the attack, entirely suspended, in nine cases out of 



THE BLOOD. 81 

ten. If this secretion appears during the progress of 
the disease, it is usually in small quantities, and free 
from discoloration. The passage of urine, under 
these circumstances, does not denote a more favor- 
able condition than when altogether suppressed ; 
but if the urine reappears, after having once ceased 
to flow, it may be regarded as an encouraging indi- 
cation. 

THE BLOOD. 

The condition of the blood, and its circulation, in- 
dicates the most positive change in the progress of 
cholera. Blood can only be drawn with difficulty 
from the veins of persons in an advanced stage of 
cholera. The small quantity that escapes is of an 
unnatural dark color and thick consistence. It is 
generally described as tarry, ropy, or like syrup. 
The change in the condition of the blood appears to 
be going on from the commencement of the attack. 
It is drained of its watery particles bv the discharges 
from the stomach and bowels, until it becomes thick, 
and ceases to flow through its natural channels. The 
veins and arteries of the extremities are collapsed 
and entirely emptied, and the larger vessels are 
choked up with the thick, semi-fluid mass. The 
attempts that have been made by distinguished med- 
ical gentlemen to restore the natural condition of 
the blood, by injections into the veins of various so- 
lutions, and also of blood from a healthy person — 
called " transfusion" — are of the most interesting 
nature to the student, but to the general reader 
would be devoid of interest. 



82 HISTORY OF THE CHOLERA. 



SENSIBILITY. 



The hearing appears to be more affected than any 
other sense. My impression, however, is, that the 
temporary deafness and ringing in the ears.- com- 

] lained of by some, is almost invariably confined to 
those persons addicted to the intemperate use of 
spirituous liquors, or tobaeco-chewers and invete- 
rate smokers. As I have before observed, the 
sight seldom seems to be affected, and if at all, only 
by a transient dimness ot vision. The taste is not 
always acute, but is generally correct and sensible of 
the contact of an irritating dose of medicine. The 
sense of smell I have not noticed particularly, 
though I remember a patient once remarking on 
the odor of a nauseating drug, which he was 
about to swallow. I have already noticed the 
acute sensibility to pain. The sense of feeling is 
certainly in no degree impaired. It is very evident. 
therefore, that the nervous system is less affected 
than any other of the functions of life. This is ra- 
cially surprising when we con -icier the large quan- 
tities of stimulating, stupefying, and other drugs 
usually administered. The patient may sink into a 
state of lethargy toward the termination :: the 
case : but he is aroused on being spoken to, will 
answer intelligibly, and again sink into a state of 
stupor. It is not always easy to determine how 
much of this condition is due to the opiates he may 
have swallowed. 



LISTLESSNES3 OR INDIFFERENCE. 83 



LISTLESSNES3 OR INDIFFERENCE. 

A singular condition of indifference is generally 

noticeable in the cholera subject. Previous to the 
attack, his fears may have been excited; he may 
have manifested alarm and dread on the approach 
of the pestilence; but, on being stricken vrith the 
malady, he becomes wholly indifferent, or seemingly 
so, and the nearer he approaches the fatal termi- 
nation, the less regard for his life does he exhibit. 
This apparent apathy has been attributed, in some 
instances, to a disinclination to acknowledge, even 
within his own mind, the near approach of death. 
This peculiarity is so frequent and so uniform, that 
it must arise from another cause connected with 
the disease; and so much is the patient under its in- 
fluence, at times, that great difficulty is found in pre- 
vailing upon him to take the remedies prescribed, 
the necessity of it not being apparent to his judg- 
ment. Though before the attack alarmed, he is 
fearless now; and this feeling of security, or indif- 
ference to the result, grows with the progress of the 
disease. After the fatal stage has been reached,, 
seldom is the least solicitude manifested as to the 
result. Indifference i3 a symptom of cholera. 



TERMINATION OF CHOLERA. 

The tendency to a fatal termination is so great in 

cholera, that experienced practitioners are of the 

opinion that no subject can recover if the disease is 

left to run its course. Xature seldom effects a cure 

8 



84 HISTORY OF THE CHOLERA. 

unaided by art. Even the skill of the physician will 
be unavailing, unless applied at the earliest possible 
moment. Hours are of more importance in cholera 
than days in ordinary diseases. The mortality in 
all countries and with all systems of practice has 
always been very great. The reputed cures of cholera 
under certain modes of treatment, or in the hands 
of certain practitioners, are derived from cases taken 
in the earlier stages only, or when the epidemic has 
spent its force, and has assumed a milder and more 
tractable type. The first appearance of the cholera 
epidemic is the most formidable, and the skill of 
the ablest practitioner is baffled. The earlier cases 
combat with medical science with singular obstinacy, 
and the sad experience of the physician gave rise, 
in his mind, to the conviction that all remedies and 
all efforts would prove ineffectual. In the fully devel- 
oped disease scarcely any treatment is of avail. We 
may surely say, then, that the apprehended result 
of malignant cholera is always unfavorable. 

As the epidemic dies out in a community, it as- 
sumes a milder and more manageable form, easily 
controlled by remedies which, a few weeks or even 
days previous, were prescribed and proved inef- 
fective. 

It is in these modified cases of cholera that many 
practitioners have earned the reputation for their 
reputed cures. 

While the epidemic rages in its malignant form, 
the physician who saves one patient in six does 
well. All his chances of success decrease with every 
minute lost. Active treatment at the very outset 



TERMINATION OF CHOLERA. 85 

of the disease is the only course for a favorable 
termination. 

When the collapsed stage has fully become estab- 
lished, there c'an be no other than the most fearful 
apprehensions. 

Accumulations of foul matter on the teeth denote 
the approach of an unfavorable result. 

The patient will not recover if the temperature 
of the mouth falls below ninety-three degrees. 

Profuse sweating indicates death. 

A cold or sour breath is fatal. 

Continual turning, uneasy movements and restless- 
ness forbodes a fatal result. 

If the cholera is complicated with any important 
disease of the internal organs, death is certain. 

The dissipated and intemperate almost invariably 
die. 

The aged seldom recover. 

Youth, if robust and of full habit, recover from 
the collapsed stage in many cases, and subsequently 
die of congestion of the brain. This danger is to 
be guarded against in all cases. 

The indications of recovery are when the vomiting 
and purging cease. 

An increased fullness of the pulse. 

A restoration of the natural warmth of the body. 

Almost any change in the color of the discharges 
from the stomach and bowels is auspicious, espe- 
cially if it is of a darker shade and of the natural 
offensive odor. If the urine reappear, it is one of 
the most favorable symptoms that can be observed. 

Recovery under the most favorable circumstances 



86 HISTORY OF THE CHOLERA. 

will generally be slow, and often embarrassed by the 
setting in of local inflammation or congestion, pre- 
senting many of the symptoms of typhus fever. 
These tendencies are to be carefully watched. The 
brain, the liver, the bowels, or the stomach may be 
the seat of the inflammatory attack. The pulse will 
become hard and full, the skin dry and hot, the 
tongue furred, the feet flushed, and sometimes de- 
lirium will set in. 

The fatal termination of cholera results from a sus- 
pension of the natural functions, and the diminution 
and gradual extinguishment of the vital powers. 

The favorable termination of cholera is simply a 
restoration of those functions and powers — a change 
which is usually very apparent whenever it takes 
place, and which often occurs when the case promises 
little hope of recovery. The transition is hailed 
with joy. Friends are delighted with the visible 
development of the newly-restored functions of life. 
The action of the heart is felt, and the arteries throb 
with promise of their wonted vigor. The returning 
heat warms us with hope, the features expand, the 
leaden hue of death is exchanged for the flush of 
life, and we congratulate ourselves with the pleasing 
thought that the sufferer has been snatched from 
the jaws of death. 



PART VI 



3^00- 



REMEDIES TRIED. 



"When nature can not work, the effect of art is yoid, 
For physic can but mend our crazy state, 
Patch an old building, not a new create." 

When the epidemic cholera first made its appear- 
ance in this country, in 1832, each practitioner went 
forth to battle with the mysterious, unknown enemy 
with such weapons only as his hasty reading or in- 
genuity suggested. The variety of treatment adopted 
indicated the uncertainty of their conclusions. They 
had the recorded experience of physicians in Asia 
and Europe to refer to for information ; but it was 
very early discovered that the remedies applicable to 
the disease in the Old World were not in all cases 
appropriate here. The whole range of the Materia 
Medica has been ransacked and almost every new 
drug tried, and, as sad experience has shown, with 
remarkable inutility, with but very few exceptions. 

At the outset of the epidemic, it was the un- 
pleasant task of the practitioner to grope in the 
dark. Unexpected was the invasion of the scourge, 

and unprepared it found all alike — the victim and 

(87) 



88 HISTORY OF THE CHOLERA. 

the physician to whom he looked for aid. Byron 
truly represented human nature when he wrote, 

"'Tis said physicians mend or end us, 
Secundum artem; but, although -we sneer 
In health, when sick, vre call them to attend us, 
Without the least propensity to jeer."' 

Physicians were called to attend the suffering and 
dying, and relying upon their own judgment, in con- 
nection with their daily experience, they gave the 
remedies prescribed by the medical men of Asia and 
Europe a fall and fair trial. The practice, however, 
laid down by them has been very much modified. 
Anions: the remedies made use of and recommended 
are the following : 

BLEEDING. 

In India, where the cholera was generally ush- 
ered in unheralded by the premonitory diarrhea, 
blood-letting was resorted to in the early stages with 
beneficial effect; but, except in occasional instances, 
it has failed to realize the hopes of the practition- 
ers of this country. It is evident that bleeding, to 
be productive of good results, must be resorted to 
before the watery portion of the blood has been 
drained from the vessels. It is said that when the 
subject is robust, bleeding, if resorted to within one, 
two, or three hours after the commencement of the 
attack, will be successful in cutting short the disease, 
by allaying the irritability and checking the spasms. 
I have never resorted to bleeding, and doubt its 
efficacy, except in cases where inflammatory or con- 
gestive symptoms are observed. 



CALOMEL — OPIATES. 89 



CALOMEL. 

So far as the experience of the past is to be relied 
on, calomel transcends all other resources in the 
treatment of malignant cholera. This opinion is 
sustained by that of the best physicians in this 
country and Europe. It allays irritability of the 
stomach and intestines, and induces a change of ac- 
tion in the liver, which is instrumental in restoring 
health. To be effective it should be given in full 
doses. If the case be susceptible of relief, it will 
correct the discharges, changing them from the 
characteristic rice-water appearance to a darker 
color and thicker consistency. This change, should 
it be effected, is an omen of good. Spasms will be 
mitigated, and all the functions will be improved. 

OPIATES. 

For a time, opium, and its preparations of mor- 
phine, was considered almost as a specific. It was 
administered freely, and in large doses, alone and in 
combination with other remedies. Subsequent ex- 
perience has, however, led to the conclusion that 
opium, although comparatively inert for a time, ex- 
erts a decidedly deleterious effect upon the vital 
powers, having a tendency to check the operations 
of nature in the struggle to regain its healthy con- 
dition. 

Opiates, then, should not be given except in the 
stage of premonitory diarrhea, and then only in 
small quantities. 



90 



HISTORY OF THE CHOLERA. 



CAMPHOR. 

Camphor has had its warm advocates, but as a 
remedial agent it is useless. It is beneficial, per- 
haps, combined with calomel, in subduing the irri- 
tability of the stomach and bowels, and, perhaps, 
has a tendency to check the spasms in the ad- 
vanced stage. It is useful in combination with 
carminatives, stimulants, and opiates in the pre- 
monitory diarrhea. It should never be given during 
the collapsed stage, on account of its determina- 
tion to disturbance of the brain. 



INTERNAL STIMULANTS. 

Stimulants, administered internally, have been 
used very freely, and in all stages of the disease. So 
far as my observation goes, I have seen but little 
benefit from the use of alcoholic stimulants, except 
in small quantities. It has been a mistaken idea 
that brandy, combined with cayenne pepper and 
other powerful stimulants, should be administered 
liberally. Much harm has resulted from such a 
course of treatment. The failing powers of life, 
the languid state of the circulation, the diminished 
heat of the body, would seem to suggest the use of 
stimulants; but they are contradicted by a knowl- 
edge of the disease, and of its tendency to local de- 
velopments — inflammation and congestion. It is 
very difficult, however, to resist the inclination to 
give a warming, stimulating draught to the patient 
sinking from apparent lack of natural heat and 
vitality. 



EXTERNAL STIMULANTS — HEAT — ICE. 91 

Brandy and water may be used in moderate doses 
to allay the vomiting and sickness at the stomach. 
Brandy and strong coffee have been also recom- 
mended. 

EXTERNAL STIMULANTS. 

Stimulants of every kind have been employed on 
the surface of the body, abdomen, and the extremi- 
ties. Mustard plasters are useful, and while there 
is any chance of making an impression, they may 
be used to advantage. Strong mercurial ointment, 
combined with cayenne pepper and camphor, was 
much in use, both in hospital and private practice, 
during the cholera of 1832 and 1850. This was 
applied to the entire surface, and the skin afterward 
covered with hot pulverized chalk or potter's clay. 
This treatment, in connection with calomel inter- 
nally, is said to have resulted beneficially in a large 
number of cases. 

HEAT. 

Heat is frequently applied externally, by placing 
around the patient bottles of boiling water, bags of 
hot sand, steam and hot-air baths, and various other 
methods devised for that purpose. My impression, 
however, is, that a stimulating ointment is preferable 
to all other modes of applying heat to the surface of 
the body. 

Experiments with the hot water and the vapor 
baths have not been productive of good results. 

ICE. 

For the relief of vomiting, ice is decidedly useful. 
Small pieces allowed to dissolve upon the tongue 
9 



92 HISTORY OF THE CHOLERA. 

will often check the nausea, and at the same time 
allay the thirst, thus removing one great cause of 
distress. 

Ice may also he employed to advantage where 
there is evident congestion of the brain — a frequent 
attendant on cholera, or more properly, perhaps, a 
subsequent disease. In the spasms of cholera, ice 
applied to the parts affected will afford relief. 

EMETICS. 

Emetics are dangerous in every stage of the dis- 
ease. They have been used and are recommended 
by a few practitioners in the incubation or forming 
stage of the disease, but experience admonishes us 
of their danger. The alarming irritability of the 
stomach and the fearful prostration of the vital pow- 
-ers forbid their use. 

There may be conditions during the progress of 
recovery when emetics would prove salutary. Some- 
times, when the system begins to react, when the cal- 
omel has changed the character of the secretions, great 
distress arises from the accumulations of large quan- 
tities of dark bile in the stomach. This may be 
relieved by an emetic, repeated at intervals ; but it 
will be safer to leave the treatment, in this case, to the 
judgment of a physician. The inappropriate use of 
an emetic may be the cause of much mischief, perhaps 
death. 

PURGATIVES. 

When the cholera has been subdued, and the sys- 
tem is returning to its healthy condition, a mild 
purgative is indicated. For this purpose, none answer 



PURGATIVES — INJECTIONS. 93 

so good a purpose as castor-oil. It is less irritating 
in its effect, and in many cases appears to exert a 
specific action on the liver. Other cathartics, pur- 
gatives, and laxatives have been recommended, but, 
unless by the advice of a physician, should not be 
used. Many of them irritate the bowels and are 
generally injurious. They are only admissible after 
a considerable change has taken place in the system 
through the action of other agents. 

Calomel is an exception to the use of cathartics 
in cholera, because its action is specific, producing 
a change in the symptoms of the disease, while its 
after effect, as a cathartic, is, no doubt, beneficial. 

INJECTIONS. 

Injections are employed with benefit under certain 
circumstances. In this way alcoholic stimulants 
may be administered with advantage, and without 
incurring the risk of disturbing the brain. 

If there is but little vomiting, an injection con- 
taining laudanum is better to check an existing 
diarrhea than to introduce large quantities of opium 
into the stomach. 

Injections of warm water will relieve the uneasy 
sensation, caused by the acrid bile in the lower 
bowels, during the recovery from an attack of 
cholera. 

Injections of hot water have been made use of, 
during the cold stage of the disease, to restore 
warmth to the system, but without beneficial re- 
sults. 



94 



HISTORY OF THE CHOLERA. 



CUPPING AND LEECHING. 

This method of abstracting blood is useful when 
there is danger of congestion, a determination of 
blood to the head, or for the relief of distress in the 
stomach or abdomen. Like general blood-letting, 
it is sometimes indispensable, but the necessity for 
its application is only to be determined by a com- 
petent medical adviser. 

TRANSFUSION. 

In consideration of the almost complete drainage 
of the blood-vessels, of serum, or the watery portion 
of the blood, thereby reducing the vital powers, it 
early occurred to the minds of medical men that 
the blood of a person in health injected into the 
veins might unite with the thick blood left in the 
heart and main arteries, and thus give new life and 
vigor to the system, and bring the sufferer back to 
his natural condition. 

Transfusion was resorted to; but, while the ex- 
periment failed in every instance to realize the hopes 
which had been entertained, the phenomena result- 
ing were of the most remarkable character. 

Another theory originated, and was tested with 
the same result. It was thought that the grand 
requisite was to supply the place made vacant in 
the arterial channels with a solution containing the 
same chemical affinities that existed in the lost blood 
when in a healthy state. A solution of certain salts 
and their proportions, ascertained by analysis, was 
made use of. The result still led to disappointment 



TRANSFUSIONS. 95 

Various solutions were injected into the veins, hoping 
to find some corrective for the diseased blood left in 
the system; but in vain. 

The immediate effect of transfusion upon the sub- 
ject is so wonderful, and yet such a positive failure, 
that the report of a few cases can not fail to be read 
with interest. 

Dr. Diffenbauch, of Berlin, Prussia, in a pamphlet 
published in 1832, referring to transfusion of human 
blood taken from a young and healthy person, says: 
"I made the injection by laying bare a vein under 
the skin in the arm, into which I introduced a small 
tube. The blood used was drawn into a warm cup, 
and the blood drawn into a syringe was thrown 
slowly into the vein. The injection was made at 
intervals, and so as to throw in, in from five to 
seven minutes, at several times, an ounce at a time. 
The operation was attended by the following phe- 
nomena: In the first instant the patient was only 
sensible of the swelling out of the veins, by which 
the blood was carried to the heart ; then came alter- 
ation of the pupils, sprightliness of the eyes, heavy 
perspiration; then return of pulsation and warmth 
of the cheeks that were previously cold. The hands 
and feet remained cold. Death succeeded the opera- 
tion in half an hour." 

Other agents, which were supposed to have the 
property of restoring the fluidity and floridness of 
blood were tried. The following case was reported 
by Dr. Carrere, of Baltimore, in 1832. The injection 
was a solution of nitrate of potash in warm water. 
He says: "We succeeded in passing about an ounce 



96 



HISTORY OP THE CHOLERA. 



of the fluid into the vein. As it passed in, the 
patient cried out with an agony of pain. He con- 
tinued to cry out at each injection. He said he had 
a rending pain in his shoulder, and complained of 
its passing inward toward the heart, when all at 
once he started up, as if suddenly alarmed. His 
face became flushed; the surface, which all day 
had been extremely cold, became warm; his pulse 
stronger, and his expression animated. He pro- 
ceeded, clearly and with considerable energy, to in- 
form us that he had suffered all day from cold feet, 
whereas he now was warm, and felt a pleasant glow 
oyer his whole body; and that we had infused new 
life and animation into his system, for which he 
wished to give us a thousand thanks. A few hours 
of seeming respite terminated in a return of collapse, 
and death closed the scene.'"' 

During the same year, at the Crosby Street Hos- 
pital, Xew York, Dr. Depeyre operated upon a yery 
robust subject, with a like result. He says: "The 
patient was suffering all the array of symptoms that 
distinguish the collapsed cholera. The solution in- 
jected stood at a temperature of 114 degrees. A 
thermometer introduced into the patient's mouth 
marked 93 degrees. All the evidences of improve- 
ment immediately ensued ; circulation re-established ; 
temperature of the body augmented; the surface 
covered with a warm perspiration; the flush and 
vigor of health restored. The man exclaimed that his 
cure was complete, and laughed aloud from ecstasy 
of relief. He was a corpse an hour after." 

Transfusion has been found wanting, and the an- 



A MULTITUDE OF REMEDIES. 97 

ticipations of medical men, who were for a time 
sanguine of the most beneficial results, have been 
disappointed. Little or nothing is to be expected 
from the practice, which, from its uniform failure, 
has been very nearly abandoned. One of the most 
experienced physicians of Xew York says the re- 
coveries have not been more than two in fifty. Still. 
success may yet result from this mode of treatment. 

A MULTITUDE OF REMEDIES. 

From such a variety of opinions as exist in re- 
gard to the cause of cholera, there has resulted a 
great diversity in the methods of treatment, and 
the very general want of success which has at- 
tended the most of them has given origin to all 
manner of nostrums and specifics. 

Electricity has been tried and abandoned. Pa- 
tients have been tortured with burning alcohol and 
hot vapor baths. Quinine and other powerful tonics 
have had a trial, with unsatisfactory results. Char- 
coal was at one time highly lauded, but has been 
laid aside. 

Innumerable mixtures and compounds, concocted 
by charlatans, have been urged upon the public as 
"infallible remedies." These are usually conglom- 
erations of stimulants, astringents, and opiates, rec- 
omended, without regard to the symptoms or stage of 
the disease, by quacks, nostrum venders, and mounte- 
banks. All such concoctions should be avoided. 

"From powerful causes spring the empiric's gains — 
Man's love of life, his weakness and his pains; 



98 



HISTORY OF THE CHOLERA. 



These first induce him the vile trash to try, 
Then lend his name, that other men may buy. 
No class escapes them — from the poor man's pay 
The nostrum takes no trifling part away; 
Time, too, with cash is wasted ; 't is the fate 
Of the real helpers to be called too late. 
They find the sick when, time and patience gone. 
Death with a tenfold terror hurries on." 



PART VII, 



>**c 



TREATMENT. 



WHAT SHOULD BE DONE. 

I desire, first of all, to impress upon the minds 
of my readers this most important of all facts, in 
connection with the treatment of cholera. What- 
ever the remedy or mode of treatment, in order that 
it may be successful, it must be applied at the very 
earliest possible moment. 

Taken in its incipient stages, cholera may be 
subdued, and the patient may be rescued from im- 
pending death. A few hours lost places him be- 
yond the reach of help. Regrets will be unavail- 
ing; the physician's skill can not save the hapless 
victim. 

True it is, indeed, that we sometimes see wonder- 
ful recoveries from even a hopeless condition of col- 
lapse. But these cases are so very rare that they 
afford no encouragement to delay the requisite 
treatment. The remedy must be appropriate and 
promptly applied. 

The chances of benefit to be derived from medi- 
cine are always less in proportion to the length of 
time that has elapsed from the commencement of 
the attack. 

(99) 



100 TREATMENT OF CHOLERA. 



PREMONITORY SYMPTOMS, 

Too much importance can not be attached to the 
premonitory symptoms, on which are suspended the 
life of the patient, and which will determine his 
fate, as they may be promptly attended to or dis- 
regarded. 

Sometimes these premonitory symptoms are of 
very short duration, and death may ensue a few 
hours after the attack. "What you do must be done 
quickly. 

Cholera is a disease so diversified in its phases, so 
erratic in its general character, that it must be 
treated in its individuality. The symptoms vary 
with the different constitutions and peculiar habits 
of the individual. 

The different stages of the malady are so dissim- 
ilar that no disease requires more care and skill. 



LOOSENESS OP THE BOWELS, 

Whenever the cholera exists in a community, or 
there is reason to anticipate its approach, then the 
most important consideration will be not to neglect, 
for even one hour, any degree of looseness of the 
bowels. This admonition is the more necessary be- 
cause this symptom of an approaching attack of 
cholera is usually unaccompanied by pain, and con- 
sequently is very liable to be disregarded as a matter 
of little consequence. Remember, the neglect to 
heed this premonitory warning has cost thousands 
of lives. 



REMEDIES. 101 

This symptom is present in almost every case. 
The opinion that cholera sometimes sets in without 
it, I am inclined to think, is a mistake, originating 
from the fact that it is painless, and consequently 
unnoticed. It may be regarded as all but a univer- 
sal symptom, and life depends on giving it im- 
mediate attention. Even in cases in which death 
takes place with the greatest rapidity, the sudden- 
ness is apparent, not real. The fatal collapse is the 
final but gradual and sure result of a neglected diar- 
rhea. Again, then, I say, life will depend on the 
promptness with which you attend to the painless 
and apparently trifling looseness of the bowels. 

It will be indispensable, in such cases, to discon- 
tinue solid food, and limit the quantity of fari- 
naceous food. Partake of fluids in moderation. 
Abstinence, in this respect, will do much toward 
restoring the stomach to a healthy condition. 

If the subject be of temperate habits, and is pru- 
dent in regard to the use of food, the diarrhea is 
generally moderate, and may continue for two or 
three days without producing much distress or pros- 
tration, but is very likely suddenly to terminate in 
collapse. 

REMEDIES. 
SLIGHT DIARRHEA. 

When the diarrhea is caused by indigestible food, 
and the evacuations are not particularly thin or fre- 
quent, and without vomiting, a dose of castor-oil 
will be sufficient, in the most of cases, to carry off" 



102 TREATMENT OF CHOLERA. 

the indigestible matter and restore the bowels to a 
natural condition. 

If the looseness of the bowels continues, the fol- 
lowing may be used: 

So. 1. 

Take of Powdered rhubard and carbonate of 

magnesia, each 20 grains. 

Compound tincture rhubarb 1 drachm. 

Peppermint water 1 ounce. 

Mix. — To be taken at one draught. 

For a still continued looseness of the bowels, de- 
noting considerable intestinal irritation, the same 

dose may be repeated, with the addition of 20 drops 
of laudanum. 

OBSTINATE DIARRHEA. 

If the diarrhea does not abate under the treat- 
ment already advised, more positive remedies should 
be resorted to without delay. 

In a choleric atmosphere, where a general dis- 
position to looseness of the bowels prevails, and 
ordinary remedies for the diarrhea appear to be 
almost powerless, I have found the greatest benefit 
from the use of an astringent powder, modified to 
meet the conditions of the case. I have used it in 
all stages of the intestinal disease, from simple 
looseness of the bowels to the most profuse and fre- 
quent discharges, if unattended by spasms, with the 
most gratifying results. TVhen decided symptoms 
of cholera have set in, its use should be discontinued. 

The following is an excellent form for general use, 
and is applicable to diarrhea in every stage: 



REMEDIES. 103 

No. 2. 

Take of Catechu and kino, each 1 drachm. 

Pulverize thoroughly, and add 

Tanic acid 30 grains. 

Powdered opium 5 grains. 

Rub together very carefully and divide into ten powders. 

The efficiency of this prescription depends mate- 
rially on the thorough trituration and mixture of 
the ingredients. 

If for a simple diarrhea, one-half of one powder 
may be taken in a little syrup. If the diarrhea 
continues, repeat the same quantity after each evac- 
uation, or increase the dose. 

Having completely checked the looseness of the 
bowels, after the lapse of a few hours, or on going 
to bed, take as follows : 

No. 3. 

Take of Blue pill 10 gTains. 

Opium 1 grain. 

Mix. and divide into two pills. 

If the diarrhea is peculiarly stubborn, and espe- 
cially if the patient is addicted to the free use of 
alcoholic stimulants, it will be found necessary to 
take the entire powder Xo. 2 at one dose, repeat- 
ins: it after each stool. 

RICE-WATER EVACUATIONS. 

If the rice-water discharges have commenced, this 
is a sure indication of malignant cholera. The dis- 
ease has commenced its attack, and mild measures 
will no longer prevail. Give immediately the fol- 
lowing : 



104 TREATMENT OP CHOLERA. 



No. 4. 



Take of Calomel 10 grains. 

Nitrate of potash 10 grains. 

One powder. 

To be repeated every half hour, till the evacua- 
tions are of a decidedly bilious character. The nitrate 
of potash will keep up a flow of the urine, or, if 
already arrested, which is most probable at this 
stage of the disease, will restore it. 

Calomel is one of the most reliable remedies we 
have in the collapsed stage of the cholera. Its 
good effects, however, are in a great degree lost if 
administered while profuse evacuations from the 
bowels and ejections from the stomach are going on. 
The remedial agent is expelled before it can pro- 
duce its characteristic action upon the functions. 
This was the result of my experience in the first 
cases I treated with calomel. Where the discharges 
were moderate, and the calomel was retained, the 
effect was most decidedly beneficial. Where the 
vomiting is excessive, chloroform has been found 
invaluable, relieving the spasms and aiding the 
irritability of the stomach. It should be adminis- 
tered as follows: 

No. 5. 

Take of Chloroform 1 drachm. 

Oil of turpentine 1 ounce. 

Water 3 drachms. 

Mix. 

Give a tea-spoonful of this mixture in a little 
weak brandy and water ; spearmint water may be 
drank to relieve the thirst. In half an hour the dose 



NAUSEA AND VOMITING. 105 

may be repeated, followed shortly after by the powder 
No. -4. The chloroform mixture will arrest the exces- 
sive drainage, enable the stomach to retain the remedy 
until its desired alterative effects are produced on 
the organs, and the secretions again How in their 
natural channels. Then we are delighted with the 
almost simultaneous development of the reanimated 
functions. A change is seen in the entire system. 
The pulse beats, warmth returns to the extremities. 
the features expand, the hue of death passes into 
the flush of life, and we know that the grim tyrant 
has released his hold on the victim. 

NAUSEA AND VOMITING. 

This distressing symptom is seldom absent long 
after the commencement of the diarrhea. It may 
frequently be alleviated by draughts of spearmint tea. 
or spirits of camphor in a small quantity of water. 

If the sickness at the stomach and vomiting is 
an early symptom, and it is clearly evident that it 
arises from eating improper food, or in conse- 
quence of overloading the stomach with that which 
of itself might, in moderate quantities, be harmless, 
and if it is clear that the food has not passed from 
the stomach into the intestines, this is the time 
for an emetic. The organs of digestion are thus 
relieved, and the predisposition to disease at once 
subdued. For this purpose use 

No. 6. 

Pulv. Ipecacuanha 20 grains. 

Calomel 5 grains. 

Let this be taken in about half a wine-glass of 



106 TREATMENT OF CHOLERA. 

water. If it be taken in a large quantity of water, 
vomiting will commence too rapidly, and the con- 
tents of the upper portion of the stomach only will 
be emptied. For the same reason, draughts of tea 
or warm water should not be taken until retching 
comes on. It may then be drank moderately to 
promote the vomiting. The calomel is used as a 
cathartic, and will serve to carry off any portion of 
the undigested food that may have passed into the 
intestines. 

The patient should be restricted to broth or gruel 
till the symptoms have been absent for a day or two. 

Do not be in haste to resume the use of solid food. 

In advising the use of an emetic, I desire to be 
distinctly understood as to the time when it should 
be employed. If it is not taken before the contents 
of the stomach have been ejected, or have passed 
into the bowels, it should not be taken at all. Except 
for the purpose of evacuating the stomach of its 
unwholesome contents, no benefit can arise from it, 
and at a later period it will be almost sure to do 
harm. The very few exceptions to this restriction 
can only be known and acted on by the advice of a 
-thoroughly competent physician. 

If the discharges from the bowels are now only 
moderate, and are not characterized by the thin 
rice-water appearance, use this mixture : 

No. 7. 

Take of Carbonate of soda 1 drachm. 

Oil of sassafras 5 drops- 
Laudanum 60 drops. 

Water 6 ounces. 

Mix. 



SUDDEN ATTACK OF DIARRHEA AND VOMITING. 107 

Take one table-spoonful every half hour or hour, 
till distress, sickness of the stomach, and inclination 
to vomit are entirely subdued. 

SUDDEN ATTACK OF DIARRHEA AND VOMITING. 

If the attack of diarrhea and vomiting commence 
abruptly and at the same time, or very nearly so, 
aud if the evacuations resemble or approach in ap- 
pearance rice-water, it is a dangerous case. The 
disease has been working insidiously and stealthily 
into the system, but has not been made apparent by 
any unusual disturbance of the functions till this 
sudden outbreak. The tongue will probably be 
clean, and the only indication of the terrible malady 
will be the unusual commotion in the stomach and 
bowels. If the pulse be full and strong, take one 
of the mixture Xo. 5. Should it be thrown from 
the stomach, repeat the dose in a few minutes, with 
a very little weak brandy and water, or mint tea, 
and, without delay, administer as follows : 

No. 8. 

Take of Calomel 20 grains, 

Powdered opium 1 grain.. 

Mix and divide into 2 powders. 

One to be taken immediately, and repeat it in one 
hour. Drink of brandy and water, or spearmint 
tea. Green mint is best, if it can be hack 

After the alarming symptoms have subsided, use 
the mixture Xo. 7, one table-spoonful every hour, or 
half hour, as the case may require.- If there is re- 
tention of the urine, give Xo. 4, as directed. A 
mustard plaster, large enough to cover the region 
10 



108 TREATMENT OF CHOLERA. 

of the stomach and liver, should be applied. As 
the disease subsides, the evacuations will become 
very dark. Convalescence will be slow, and extreme 
caution must be exercised in regard to diet. Re- 
member, no solid food must be taken into the 
stomach until several days have elapsed after re- 
covery is supposed to be complete, and then it must 
be partaken of in great moderation. 

Mr. Branon, aged fifty- eight, a tall, muscular, and 
powerful man, journeying westward in August, 1850, 
with his wife and two daughters, while stopping tem- 
porarily at the Monroe House, St. Louis, was suddenly 
attacked with violent purging, vomiting, and spasms. 
When I saw him his pulse was small and quick, 
discharges like rice-water, extremities cold. I di- 
rected mixture similar to "No. 5, followed, in half 
an hour, by calomel 10 grains, and pulverized opium 
1 grain ; repeated twice. Mustard plasters were ap- 
plied to the stomach and extremities. Bowels opened 
with bilious evacuations. Recovered rapidly, and 
on the fourth day expressed himself as well as ever 
in his life. The next day he was to have taken 
passage with his family on a boat bound for St. 
Paul. Up to this time, he had been restricted in 
his food to broth, gruel, or soup. ^N"o longer feeling 
the necessity for such restraint, he partook of a little 
mutton with bread, butter, apple-sauce, though very 
sparingly. This was at about 2 o'clock P. M. At 
half-past 4 he was in a state of relapse, and died 
during the night. 

Such instances were not uncommon, and must 
serve to impress the patient with the great necessity 



SPASMS — DELIRIUM. 109 

for particular prudence in regard to partaking of 
solid food for a considerable period of time after 
convalescence. 

DISTRESS AT THE STOMACH WITHOUT PURGING. 

It happens occasionally, during the cholera period, 
that patients complain of distress at the stomach, prob- 
ably with headache and impaired appetite, but no 
diarrhea. The tongue will be coated. This will be 
the first symptom, and should not be neglected. Ten 
grains of calomel, or a dose of castor-oil, with a 
blister over the stomach, will usually be sufficient in 
such cases. 

SPASMS. 

Spasms may occur at any stage of the disease. 
Sometimes, though rarely, they present the first in- 
dication of the malady. Spasms, however, usually 
occur in combination with the other symptoms. 
Stimulating embrocations and friction to the parts 
affected are the means generally resorted to for re- 
lief. I have found ice applied to the parts affected 
productive of beneficial results. Ice is admissible 
in any stage of the disease. The chloroform mix- 
ture, iso. 5, should be resorted to. 

DELIRIUM. 

This rarely occurs. Occasionally, however, there 
is an obstinate determination of blood to the head, 
with inflammation of the brain. The case requires 
immediate attention. Call in the aid of a physician 
without delay; in the mean time applications of ice 
should be made to the head, and I have known ice, 



110 TREATMENT OF CHOLERA. 

broken fine and rolled np in a cloth, placed along the 
spine, to afford prompt relief. 

If the symptoms of congestion are not relieved 
at once, the patient passes through the different 
stages of purging, vomiting, collapse, delirium, and 
death. 

COLD SURFACE AND EXTREMITIES. 

When we see the cold, shriveled skin of the cholera 
patient covered with beads of clammy sweat, our first 
and natural impulse is to apply heat, in every pos- 
sible shape, externally. Experience, however, has 
shown that many of these applications are useless — 
indeed they are worse than useless, for they only 
serve to torture the already suffering patient, who is 
unusually sensitive to the pain occasioned by heat, 
although the effect even of boiling water is not ap- 
parent to the observation. Dry friction is almost 
entirely useless, except when directly applied to the 
muscles contracted with spasms. In this way great 
relief may be obtained. 

COLD PERSPIRATION. 

The very best application for a cold surface and 
cold perspiration I found to be as follows : 

tfo. 9. 

Take of Lard 1 pound. 

Red pepper 2 ounces. 

Mix. 

Simmer well together, and apply while quite hot, 
with a piece of flannel, to the entire surface, rubbing 
briskly until warmth is restored to the body. 

The above preparation, kept warm and faithfully 
applied, will do more toward restoring a natural 



CONVALESCENCE. Ill 

glow to the body and checking the cold perspira- 
tion than any external stimulant of which I have 
any knowledge. 

Olive oil, saturated with camphor and red pepper, 
may be used with great advantage. Cajeput oil is 
also highly recommended. I have never tried the 
latter, but believe it would be beneficial. 

Stimulating ointments were used quite extensively 
in the hospitals and in private practice during the 
two visitations of cholera with which we have been 
afflicted. In another place will be found the method 
of preparing these ointments. Their use would no 
doubt prove salutary; but I. am confident that the 
simple preparation of lard and pepper, as advised, 
will answer as good if not a better purpose in all 
cases. 

CONVALESCENCE. 

Recovery will always be slow, and its progress 
must be carefully watched. It will be constantly 
necessary to act with reference to any possible local 
disturbance of the system that may occur, particu- 
larly as to the development of inflammatory symp- 
toms. The brain, the liver, the bowels, the stomach, 
are, each and all, liable to be attacked. The symp- 
toms very much resemble those of typhus fever. 
Very little need be done through the agency of 
internal remedies while the febrile symptoms are 
mild and no particular organ is involved. If, how- 
ever, there is high fever, the pulse becomes full and 
hard, the skin dry and hot, the tongue dry and 
coated, the face flushed — in the absence of a physi- 
cian — procure the following: 



112 



TREATMENT OF CHOLERA. 



No. 10. 

Take of Tartar emetic 2 grains. 

Spearmint water 4 drachms. 

Water 1^ ounces. 

Mix. 

Take two tea-spoonfuls every hour, till the alarm- 
ing symptoms abate. Iu all cases where, during con- 
valescence, there are indications of inflammation of 
the brain, liver or other organs, administer No. 10, 
as greeted. Be very careful in having the pre- 
scription put up, and be very precise as to the exact 
quantity and the stated interval of time directed. 

Ice is a useful application to the head in cases of 
inflammation of the brain, and where the liver 
or stomach becomes the seat of the disease, apply 
mustard plaster over the affected part. The pa- 
tient must be restricted to a very rigid diet, and 
on the abatement of the more aggravated symp- 
toms, must observe the most temperate and regular 
habits. Thus, by careful nursing and watching, the 
convalescence of the patient may be conducted to a 
favorable termination. 

REMARKS. 

It has been already shown that the prelude to 
cholera is a disarrangement of the intestinal func- 
tions, manifested by a "looseness of the bowels" 
and diarrhea, and that the proper course to be pur- 
sued is to arrest the incubating tendency in its 
incipiency. The remedies I have suggested for this 
purpose, if properly and promptly administered, will 
be sufficient to accomplish this result in almost 
every instance. 



REMARKS. 113 

Medicines, especially for the " diarrhea and chol- 
era," of every namahle and unnamable description 
that quackery and empiricism can devise, will be 
urged upon you during the prevalence of the chol- 
era. " Touch not, taste not, handle not." 

If the diarrhea is checked by the simple means I 
have advised, the stomach and intestines will be left 
in a healthy condition, and the predisposition to dis- 
ease will be lessened; while, if the looseness of the 
bowels is stayed for a time by the vile compounds of 
patent medicine peddlers, you will be sure to suffer 
all the pains and penalties attached to the introduc- 
tion of irritating drugs into the stomach ; so that, 
should you be stricken down with cholera, the mu- 
cous membrane being in an irritable condition, in 
consequence of the ill-directed nostrums swallowed, 
the functions will break down at once, and you are 
beyond all antidote. 

"Out! you impostors! 
Quack-salving, cheating mountebanks ! — your skill 
Is to make sound men sick, and sick men kill." 

Diarrhea is constantly confounded with the dis- 
charges from the bowels incidental to the true or 
collapsed stage of the cholera. None, however, need 
err in this respect; the commencement of the malig- 
nant disease is easily distinguished by the most 
common observer, if the description of the symptoms 
is carefully noted. 

It is essential that this distinction should be un- 
derstood, because the remedies that will effect a cure 
of the antecedent affection of the bowels will, in 
this stage, prove altogether inefficient. The mistake 



114 TREATMENT OF CHOLERA. 

as to the distinction to be observed between the 
treatment of "premonitory diarrhea" and the true 
stage of cholera, has led to much misjudged abuse 
of calomel. Those who condemn its use assert that 
" other remedies are more efficient and less injurious." 
They have confounded diarrhea with cholera, and 
have succeeded in curing the premonitory disease. 
Cholera-morbus, too, is sometimes mistaken for col- 
lapsed cholera, and the patient having been restored 
to a state of health by the use of opiates, stimulants, 
emetics, carminatives, etc., it is proclaimed as a cure 
of cholera, and cited as evidence that this malig- 
nant disease may be successfully treated without the 
use of calomel. 

Let these medical wise-say ers administer their 
vaunted remedies in a case of real " asphyxiated 
cholera," and their fallacy will be made fearfully 
apparent. The reckless and indiscriminate use of 
calomel is certainly to be condemned ; not more so, 
however, than the meaningless and injudicious use 
of any other remedy, whether mineral or vegetable, 
arsenic or belladonna. Were only u mild and innox- 
ious drugs " made use of in practice, the reformer's (?) 
materia medica would be reduced to a very insig- 
nificant catalogue. I do not intend to discuss this 
subject, however. Such a course would be entirely 
foreign to the object of this book. 

My first experience in the use of calomel, as I 
stated in the introductory chapter, was unfavorable. 
Subsequent observation confirmed an idea that origi- 
nated in my mind that its salutary effects were coun- 
teracted by the opium with which it had been 



REMARKS. 115 

combined, and which tended directly to paralyze 
those functions already in a sluggish and torpid 
condition, and which it was indispensably requisite 
to restore to a new and healthy action. For the 
accomplishment of this result, calomel was unques- 
tionably the most appropriate agent; but as its re- 
tention upon the stomach had been secured by the 
use of opium, the very object for which it was ad- 
ministered was thereby defeated, and the action of 
those functions was checked by the opiate which 
the calomel was intended to restore. Calomel allays 
the irritability of the mucous membrane, and, what 
is of the most vital importance, quicker than any 
other remedy, induces that change of action which 
is necessary to the re-establishment of health. It is 
almost specific in its mode of action, and its cathartic 
effects are beneficial, if not essential, to the change 
it exerts. As I have already said in reference to its 
use, sometimes the evacuations and ejections are so 
continuous, and in such enormous quantity, that 
the medicine is carried from the system before it 
can produce its specific action. In this case, give 
the mixture ~No. 5, repeating the dose every hour or 
half hour, till the discharges cease. Calomel is then 
indicated, as directed in prescription ISTo. 4. 

Cases occur where, from some unusual exciting 
cause, the patient is stricken down at once with the 
most violent symptoms, congestion of the brain, 
with spasms, and suffering the most intense agony. A 
physician should be procured immediately. In the 
absence of medical aid, apply ice to the head, and 
administer, as directed, ISTo. 10. Where mustard 



116 TREATMENT OF CHOLERA. 

plasters are used, the ground mustard should be 
made into a thin paste, and applied directly to the 
skin over the region of the stomach. Renew them 
as often as they cease to produce a burning sensation. 
Ice, in small pieces, may be used to allay the thirst. 

If the patient has been much accustomed to the 
use of stimulating drinks, brandy and water may be 
given to allay nausea and vomiting. Brandy, com- 
bined with strong coffee, in small quantities, has 
sometimes been used for the same purpose, with good 
effect. When calomel has accomplished its desired 
result in changing the secretions, castor-oil answers 
a better purpose as a cathartic than any other agent. 
It not only moves the bowels gently, but appears to 
exert a direct action on the liver. If castor-oil is 
objectionable on account of its disagreeable taste, 
the next best cathartic is tartrate of potash. Take 
one drachm, in a little warm chicken-broth, every two 
hours, until it operates freely. 

For spasms, spirits of camphor, or camphorated 
oil, may be rubbed on the parts, with salutary results. 
Internally, camphor used in any considerable quantity 
is liable to produce a determination of blood to the 
brain. In small doses it answers very well for sick- 
ness at the stomach, but is not as good as spearmint 
or peppermint tea in small quantities. 

Injections are rarely resorted to. Sometimes, where 
diarrhea exists without vomiting, laudanum has been 
administered in this way advantageously, and alco- 
holic stimulants are better administered by this mode 
than by the mouth. By those who have made use 
of this method, it is said to impart heat and vitality 



REMARKS. 117 

to the intestines, without disturbing the functions of 
the stomach or brain. 

As an internal stimulant, aqua ammonia may be 
used with advantage, diluted with an equal quantity 
of water, one table-spoonful at a dose, repeated as 
occasion may require. 

I have already alluded to the use of lard and other 
oleaginous preparations externally, for the purpose of 
checking the profuse secretions through the pores of 
the skin, and restoring warmth to the body. Several 
stimulating ointments were made use of for this pur- 
pose during the epidemics of 1832 and 1850. Their 
use is said to have been attended with beneficial re- 
sults. 

No. 11. 

DR. ROE'S OINTMENT. 

Take of strong mercurial ointment 6 ounces. 

Cayenne pepper and camphor, each 3 ounces. 

Thoroughly blend together the ingredients, and rub 
the entire surface of the body with a brush. 

This prescription was used in New York hospitals, 
and was pronounced an excellent aid in co-operation 
with internal remedies; while checking the cold 
sweat, producing salutary constitutional changes in 

the functions. 

No. 12. 

DR. RHINELANDER'S OINTMENT. 

Take of simple ointment 6 ounces. 

Melt and add 

Cayenne pepper 3 ounces. 

Camphor 3 ounces. 

Muriatic acid 4 drachms. 

Stir the mixture well together, till cool. 



118 TREATMENT OF CHOLERA. 

Apply freely to the whole surface. 

~No doubt these ointments may be beneficial. My 
impression, however, is that the simple melted lard 
will be found quite as effective in all cases. 

ACETATE OF LEAD. 

I have seen cases of cholera of the milder form 
conducted to a favorable termination by the use of 
the acetate of lead. I found this agent particularly 
effective when the epidemic appeared to be dying 
out, and had evidently assumed a less malignant 
type. It may be used as follows : 

No. 13. 

Take of Acetate of lead 18 grains. 

Opium 1 grain. 

Make into 12 pills. 

One pill to be taken every half hour, till the dis- 
charges from the bowels begin to diminish; after 
that, at longer intervals, as the symptoms may ap- 
pear to indicate. 

dr. Warner's treatment. 

Another method of treatment has met with some 
favor among those who reject calomel. It was origi- 
nally adopted by Dr. Warner, in his hospital practice 
in Baltimore, in 1832, as he claimed, with decided 
success. 

In case of an attack commence with 

No. 14. 

Take of Tincture of asafoetida 3 drachms. 

Follow this with 1-drachm doses every half hour. 



DR. WARNER S TREATMENT. 119 

During the interval between the first and second 
dose of asafcetida use as follows : 

No. 15. 

Take of Pulverized rhubarb 10 grains. 

Nitrate of potash 5 grains. 

Pulv. squill ^ grain. 

Sulphate of quinine 3 grains. 

For one powder. 

To be taken in a little weak brandv and water, and 
to be repeated every hour. Brandy and water, in 
small quantities, may be occasionally swallowed, 
whatever internal method of treatment may be 
adopted. Apply mustard plasters to the stomach 
and abdomen, and make free use of hot lard oint- 
ment on the surface, as already directed. 

The two methods here given for the treatment 
of cholera without the use of calomel have found 
earnest and sincere advocates. ]STo doubt good re- 
sults have been derived from each. 

My judgment is decidedly in favor of calomel. I 
am confident, when the system comes under its char- 
acteristic influence, and is sustained by the proper 
auxiliary aids, as I have heretofore suggested, it will 
bring the disease to a favorable issue. 

If the patient entertains a prejudice against the 
use of calomel, unless he is more regardful of his 
preconceived opinions than he is of his life, he will 
do well to adopt this agent. 

be prepared: 

"For yrhen men think they most in safety stand, 
Their greatest peril, often, is at hand." 

During the invasion of the epidemic cholera, 



120 TREATMENT OF CHOLERA. 

every family and every individual not in a position to 
obtain immediate aid, should be provided with the 
necessary medicines to be used in case of an attack. 

Have on hand — Castor-oil, pulverized rhubarb, 
paregoric (useful for children's diarrhea), lauda- 
num, ground mustard, red pepper, lard, spear- 
mint or peppermint (as fresh as possible), spirits of 
camphor. 

The prescriptions necessary to have on hand are 
as follows. Be careful to copy correctly. They can 
be obtained at any drug store. Have the package 
numbered to correspond with the number in this 
book, and have the ingredients written out in full 
upon the wrapper or envelope containing each. In 
this way you will avoid mistakes : 

No. 1 can be obtained at any drug store when 
wanted. 

]STo. 2. — This is the most important of all the rem- 
edies in the catalogue, because it is always a safe 
and sure remedy for looseness of the bowels, diar- 
rhea, all relaxed conditions of the bowels, the 
dose, and the intervals of time for its exhibition, 
being graduated according to the character and 
severity of the disease. The suggestions already 
made will be a sufficient guide for this purpose. 
No person traveling should be without a package of 
these "astringent powders." It can be carried in 
the vest pocket or portmonnaie, and in case of an 
attack of diarrhea a small quantity can be taken 
without inconvenience, and will prove a sovereign 
remedy. Many an invasion of cholera has been and 
may be thus repelled. 



REMEDIES. 121 

No. 3. — It will be well to have a few of these pills 
prepared and ready for use in the house. 

No. 4 may be kept on hand, or it can be obtained 
when required, if you have a druggist near by. 

No. 5. — To be mixed as required. 

No. 6. — If not provided with this emetic, or it is 
not convenient to procure it, use salt and warm 
water. The powder is much the best, however. 

No. 7. — Procure whenever wanted. It is a most 
excellent adjunct to other remedies, and it will be 
well to have the carbonate of soda and oil of sassa- 
fras in the house, so that the mixture may be pre- 
pared when needed; (six ounces will be about two- 
thirds of a common tumbler full). 

No. 8 should be kept on hand, as the occasion in 
which it may be required admits of little delay. Un- 
less a druggist lives near by, it should be prepared 
ready for use. 

No. 9. — Prepare ready for use. 

No. 10 can only be compounded when wanted. 

No. 11, No. 12, No. 13, No. 14 and No. 15 can 
be prepared at any drug store by those who wish to 
make use of them. 

The following is an excellent mixture to have in 
the house or workshop. It is to be used in cases of 
any unusual disturbance of the stomach and bow- 
els, or where there are cramps : 

No. 16. 

Take of Laudanum 3 drachms. 

Spirits of turpentine 3 drachms. 

Oil of peppermint 30 drops. 

Mix. 



122 TREATMENT OF CHOLERA. 

From a tea-spoonful to a table-spoonful to be taken, 
with a little weak brandy and water, every hour, till 
relieved. 

HOW TO TAKE CASTOR-OIL. 

Take half a cup of water, half a tea-spoonful of 
essence of peppermint; sweeten with sugar; pour 
into this the oil; it will float upon the water, and 
the whole may be swallowed at a draught, the water 
preventing it from adhering to the mouth, and the 
peppermint completely disguising the taste of the 
oil. The dose of castor-oil is from one to two table- 
spoonfuls for an adult. 

MEASURES. 

A common tea-spoon contains about one drachm. 

A common dessert-spoon contains about three 
drachms. 

A common table-spoon contains about five drachms. 

A common wine-glass contains about two ounces. 

Where precision is required, a graduated glass, 
which will indicate from five drops to one or two 
ounces, should be used. Such a measure can be pur- 
chased for a trifle at the drug store, and will always 
be convenient and safe for the administration of 
medicines in a family. 

THE DOSES OF MEDICINES FOR CHILDREN. 

It is very difficult to give any precise rule for the 
doses to be administered to children in cases of chol- 
era. The general rule observed will hold good in 
these remedies, and can be followed very nearly. 



l-8th « 


c <( 


l-6th < 


( u 


l-4th « 


< u 


l-3d « 


< u 


1-half « 


( u 



DIET. 123 

For a child under 1 year the dose should be l-12th of that of an adult. 
it m 2 " " 

n u 3 « u 

<< it 4 u n 

« tt 7 it ii 

ii <( 24 " " 

The dose of calomel or castor-oil for a child is 
larger in proportion, and laudanum less, than for an 
adult. 

Women require smaller doses than men. 

One of the most important circumstances to be 
considered in this connection is, that persons habit- 
uated to the use of alcoholic stimulants, malt liquors, 
and tobacco require much larger doses to affect 
them in cholera. This should be remembered. 
Other influences may affect the system and modify, 
in some degree, the action of medicines; but the 
rules given are sufficiently precise to enable the 
reader to use and administer the remedies I have 
advised in almost any case of cholera. 



DIET. 

I have repeatedly, during the course of this 
treatise, alluded to the great necessity for caution 
in the use of solid food. Very little nourishment will 
be required until convalescence sets in; then, as a 
rule, the severer the attack has been the greater the 
necessity for diluted and light food. 

In the earlier stages of convalescence, the food 

should be of a farinaceous description. Animal 

broths should not be indulged in. I have seen much 

mischief result therefrom. Barley-water and toast- 

11 



124 TREATMENT OF CHOLERA. 

water will be grateful to the taste and afford nour- 
ishment. I have had reason to suppose that corn- 
meal gruel was injurious. I would not recommend 
it. Farina, tapioca, sago, and rice constitute the basis 
of excellent articles of diet; but they must be well 
cooked, of thin consistency, and but little seasoned. 
Not one particle of food should pass into the 
stomach in a solid state. 

Gradually, after the third or fourth day, a change 
of diet may be allowed. Chicken broth, mutton 
broth, and other liquid animal food, should be re- 
sorted to; but, with these exceptions, it will be well 
to confine the diet to the mucilaginous or farinaceous 
compounds for some time to come, and eat of those 
only in moderate quantity. 

When convalescence is complete, a more generous 
diet is admissible; but solid food should be eaten 
only sparingly. Fish should not be indulged in. 

That the convalescent may be duly impressed with 
the vital importance of giving heed to the admoni- 
tions I have uttered in regard to diet, I extract from 
a valuable work on epidemic cholera the remarks of 
the author, Dr. Jameson: "One of the greatest dif- 
ficulties attending cholera was to get our patients 
in a condition to bear food. The digestive functions 
were much weakened, and it was w T ith extreme 
difficulty patients could resume the use of the mildest 
articles of food. We had often seen injury arising 
from the use of food in bilious and other fevers, but 
never did we see any thing bearing any comparison 
with this circumstance as it stood related to cholera. 
In both hospitals patients injured themselves in that 



THE 0HOL1RA MEDICINE c.\ - 125 

-ay. in spite of all precautions, and many died from 
leir imprudence. In many instance.-, nothing but 
ruel. sago, toast-water, common tea, or other drinks, 
pially mild, could be borne for upward of a week, 
nd in private practice we found the same difficulty 
i getting our patients to resume their accustomed 
hxL owing to the liability to a relapse." 

I have given such directions for the treatment of 
tiolera as will enable any person of ordinary intel- 
genoe to meet an attack of the terrible malady with 

reasonable chance of successfullv resisting its 
readed termination. To secure this hoped-for re- 
alt have the medicines in your possession, and 
dminister them, according to directions, with as 
ttle delay as possible. 



PART VIII. 



-*o^o«- 



MEASURES FOR PREVENTION. 



"An ounce of prevention is better than a pound of cure." 

It is urged, by some, that the varieties of food and 
the moderate use of stimulants, to which we are 
accustomed in a state of health and in ordinary con- 
ditions of the atmosphere, will be harmless during 
an epidemic, and should be partaken of then as at 
any other time, being careful to abstain from excess 
or over-indulgence. 

This reasoning is plausible, and generally finds 
encouragement in the sentiment of the community, 
which will be in favor of a moderate indulgence in 
fruits and the luxuries of the table, as well as in the 
use of wines and liquors. Inclination is a powerful 
persuader. 

An eruption of cholera, however, very quickly 
proves the fallacy of this theory, and the experience 
of those who have passed through the epidemic pe- 
riod has been very conclusive against many articles 
of food and drink, which have usually been par- 
taken of without restraint. 

The epicure finds his accustomed delicacies ejected 
from his stomach undigested. The veteran wine- 
(126) 



INTEMPERANCE. 127 

drinker is astonished to wake up in the morn- 
ing, after an evening's indulgence, with his bowele 
in a fearful state of commotion. The argument is 
perfectly convincing. The presence of a pernicious 
atmospheric influence is readily acknowledged. The 
gentle reminder is quite sufficient to put him on his 
guard for the future. 

An unusual influence is unhesitatingly admitted, 
and the opinion soon becomes general that personal 
safety requires an abstinence from articles of food 
heretofore considered wholesome. Every one feels 
a conviction that moderation and temperance, in 
eating and drinking, are essential to his protection. 

The atmospheric influence is manifested by re- 
markable irritability of the stomach and bowels. 
Very few admit this fact, however, till they make 
the experiment, and if they are admonished thereby, 
they will be very likely to pass through the ordeal 
in safety. 

The debauchee, the intemperate drinker, the jolly 
good fellow, accustomed to late suppers and the 
flowing bowl, will materially lessen the chances of 
falling a victim to the scourge if he will abstain 
from his convivial habits and observe a moderate, 
well-regulated system of eating, drinking, and sleep- 
ing. 

Persons of constipated habits should never at- 
tempt to open their bowels by the use of any arti- 
cle of food. It should be done by mild cathartic 
medicines. Castor-oil is the best. Never use any 
of the saline purgatives for this purpose. Epsom 
salts, citrate of magnesia, cream of tartar, Rochelle 



128 MEASURES FOR PREVENTION. 

salts and seidlitz powders are dangerous, because, al- 
though they do not act harshly, they produce watery 
evacuations, and have a tendency to reduce the tem- 
perature of the system, both of which results are 
to be avoided. 

Whenever a purgative is required, use a mode- 
rate dose of castor-oil, or some one of the mild aro- 
matic laxatives. Do not take a purgative medicine 
over night. 

If the action of a purgative is too free, it should 
be checked with a few drops of laudanum. 

In the rules laid down for the prevention of chol- 
era, a distinction should be made between a place 
where the disease already exists and a place where 
it has not yet made its appearance. 

Where the epidemic exists, the restrictions in re- 
gard to eating fruit and vegetables should be care- 
fully attended to. 

Where the epidemic does not prevail, a prudent 
use of fruit and vegetables can do no harm. 



INTEMPERANCE. 



"Fatal effects of luxury and ease, 
We drink our poison and we eat disease." 

The evils to be dreaded from intemperance can 
not be too strongly impressed upon the minds of 
those who have unfortunately been addicted to this 
vice. Intemperance at any time is sure to entail a 
list of "aches, pains, and diseases dire" upon its 
victims, which must eventually cut short the sum 
of existence ; but, with an epidemic prevailing, it is 



RULES FOR INDIVIDUALS. 129 

dangerous in the extreme. Besides predisposing to 

the attack, it renders the subject, when stricken with 
the disease, unimpressible to all remedies. As an 
evidence of the fatal results of intemperance, the 
statistics of the cholera in St. Louis may be re- 
ferred to. In 1849 and 1850, in that city, as in most 
of Southern and South-western cities at that date, 
Sunday was usually devoted to pleasure and recrea- 
tion. The laborer, the mechanic, the .clerk, the 
tradesman, in fact large numbers from all classes of 
society appeared to look to that day, not only as a 
weekly rest from toil, but as a sort of holiday. As 
a matter of course intemperance and other vices 
were in the ascendant, and when the epidemic ap- 
peared, as advised by the Sultan of Turkey, many of 
the people gave unwonted looseness to their appetites, 
evidently under the impression that in this way 
they would free themselves from fear and danger 
of an attack; that a jolly life, and a merry one, 
would keep the evil from their doors. 

The result was that the greatest mortality of the 
week almost invariably occurred on Monday, with a 
gradual decrease from that day until the return of 
Sunday. 



RULES FOR INDIVIDUALS. 

Give immediate attention to any disturbance of 
the bowels. It is the first indication of the coming 
malady. Check it while you can. 

Keep out of the night air, and avoid the dews of 
the morning. 



130 MEASURES FOR PREVENTION. 

Keep the body clean. Wash the entire body 
every week; two or three times will do no harm. 
A dirty skin will invite the attack. Change your 
under-clothing frequently. 

Wear flannel next the skin. It will protect 
against sudden changes of temperature. 

Do not sleep on the lower floor, or in a small 
room with several persons. Cold water should be 
drank cautiously in warm weather. Ice-cream I have 
known to produce sudden and fatal attacks. Avoid 
as much as possible over-exertion and fatigue. 

Do not give way to alarm. Fear and all the de- 
pressing passions are great provocatives to the dis- 
ease. 

Therefore, endeavor to keep a cheerful mind, and 
if attacked, never think for a moment but what you 
will recover. There is wonderful tonic power in 
faith. 

Do not fear danger from contact with the sick. 
The cholera is not contagious. 

Indulge in rational amusement. Do not sit too 
long, however, in a crowded room. 

"Fear to our coffin adds a nail, no doubt, 
And every grin, so merry, draws one out." 

There is no question but that, as a general rule, 
persons of cheerful dispositions, regular, temperate, 
and cleanly in their habits, are much less liable to 
an attack of cholera than those who are negligent 
and careless in these respects. 

" Our remedies oft in ourselves do lie, 
Which we ascribe to heaven." 

Those persons and those communities who pay 



REMARKS. 131 

most attention to the observance of the plain laws 
of hygiene — the laws of God and nature — are 
passed by, while those who trust to bravado and a 
total neglect of the common rules of living are the 
first victims. 

Be temperate in eating and drinking. Eat your 
meals at stated hours. 

Abstain from stimulating drinks — ale and lager 
beer, as well as alcoholic liquors and wines. 

Fish of all kinds are dangerous. 

Avoid fruit. Even when ripe, it is liable to pro- 
duce fermentation in the stomach. Unripe fruit is 
death. 

Garden vegetables should be partaken of sparingly, 
if at all. 

Cabbage, sauer-kraut, cucumbers, water-melons, 
etc., should be banished from the table. 

During the prevalence of cholera it may be con- 
sidered a sure thing that whatever tends to disturb 
the equilibrium of the system may lead to an attack. 

The diet should be nourishing, warming, dry, and 
easily digested. 

All excesses should be avoided. 

Lean fresh meat, good potatoes, cold bread, rice, 
eggs, milk, butter, tea, and coftee, will afford a meal 
unattended with danger. The closer you confine 
yourself to these articles of food the better. 

Pastry, puddings, cheese, pickles, and such like 
et ceteras, should be scrupulously avoided. 

Eat moderately. Do not indulge in varieties of 
meats at the same meal, and swallow no more than 
the stomach can easily digest. 
12 



MEASURES FOR PREVENTION. 

• If thou wilt observe 
The rule of "not too much,' by temperance taught, 
In what thou eatst and drink'st, seeking from thence 
Due nourishment, not gluttonous delight. 
Then many years may o'er thy head return. 
So may'st thou live till, like ripe fruit, thou drop 
Into the lap of mother earth; with ease be 
Gathered, not harshly pluck d, in death mature." 

IN AND ABOUT YOUR HOUSES, 
"Cleanliness is next to godliness." 

Take up your carpets and have them well cleaned; 
let no dirt accumulate beueath them. 

See to it that your mattresses, beddiug, and hang- 
ings are thoroughly aired and cleansed. 

Have every room in your house regularly and 
thoroughly ventilated. 

Sleep in a chamber, or upper room, if possible. 

Whitewash your walls, cellars, out-houses, fences. 
Lime is a purifier. 

Keep the sewers, drains, and sinks free from ac- 
cumulations of filth and refuse matter of every 
description. 

The garbage and offal should be promptly removed. 

Allow no decomposing vegetable or animal matter 
to remain on your premises. 

Take one pound of chloride of lime, put it into 
a bucket of water, and after stirring it, every day, 
sprinkle a small quantity wherever foul air can pos- 
sibly exist. Cellars, kitchen drains, back yards, and 
privy vaults should receive a portion. 

Half a pound of sulphate of iron (copperas), and 
half a pound of sulphate of copper (blue stone), 



IX AND ABOUT THE HOU8S. L83 

dissolved in a bucket of water, is the beel deodor- 
izing and purifying agent thai can be used for 

privies. Throw a portion into the vault, and allow 
the vessel to remain in the privy, stirring it oc 
sionally. Both this mixture and chloride of lime 
will injure the clothing if it comes in contact 
with it. 

Do not drink river water, or use it for cooking 
purposes, unless previously tiltered or otherwise puri- 
fied. Hydrant-water holds in suspension a large 
amount of animal and vegetable matter. This re- 
striction I know to be of the utmost importance, 
in large cities, during the prevalence of cholera. 

The purest water that can be obtained is from 
condensed steam, and in manufactories run bv steam 
and on board of steamboats this is easily obtained. 
A barrel in a convenient position will hold the water 
as it is condensed from a steam-pipe arranged for 
this purpose. This water, for cooking purposes on 
board of steamboats, and, when properly cooled, for 
drinking, is the healthiest that can be used. 

Cleanliness in the sick room is of the most vital 
importance, not only to the patient, but to the at- 
tendants and friends who assist him. 

The evacuations from the stomach and bowels 
should be immediately removed to the privy vault. 
A vessel containing a solution of the chloride of 
lime, chloride of soda, or sulphate of iron, should 
be kept constantly in the room. 

Be extremely careful that no portion of the mat- 
ter evacuated from the system remains on the bed- 
clothing, carpet, floor, or furniture. Throw a little 



134 MEASURES FOR PREVENTION. 

of the disinfecting solution into the vessel used by 
the sick person. In short he scrupulously clean. 

Strict attention to the rules laid down will afford 
great protection, and materially lessen the chances 
of an attack of cholera. 

Whenever the epidemic makes its appearance, 
every individual should give special attention to the 
state of his health. 

Attend to the condition of the stomach and 
bowels. Eat and drink in moderation. Be careful 
not only in regard to what kind of food you eat, 
but also as to how much you eat — quantity as well 
as quality. 

Xeep the mind as free as possible from all undue 
apprehension of danger, and cholera will be disarmed 
of much of its power for evil. 



FOOD FOR THE SICK AND CONVALESCENT. 

The diet of the convalescent is of the most vital 
importance. The few preparations given herewith 
will be found excellent and quite sufficient for the 
first few days. 

ISINGLASS JELLY. 

Take two ounces of isinglass, two pints of water; 
boil to one; strain, add a little milk, and sweeten 
with white sugar. 

THIN RICE. 

Rice, three spoonsful ; boil in two pints of water 
to one ; strain ; flavor with cinnamon, and sweeten 
with white sugar. Drink it warm. 



FOOD FOR THE SICK AND CONVALESCENT. 135 



BREAD JELLY. 

Boil a quart of water and allow it to cool. Take 
about one-third of a baker's five-cent loaf, slice it, 
take off the crust, and toast to a light brown; then 
put it into the water, cover tight, place it on the 
coals or a stove, and boil gently. Try it occasionally 
by cooling a portion in a spoon ; when it becomes a 
jelly, remove it. Strain; warm a little when it is to 
be used; sweeten with white sugar, flavor with 
lemon-peel. 

TAPIOCA JELLY. 

Take of tapioca two spoonsful; water, one pint; 
boil gently for an hour, or till it assumes a jelly-like 
appearance; add sugar and nutmeg to suit the taste. 

SAGO. 

Wash the sago well, and let it soak for two or 
three hours. To a tea-cupful of sago add a quart 
of water and a small piece of lemon-peel ; boil 
gently, till it becomes a transparent mass. When 
nearly done, add a little sugar, and boil for a few 
minutes. 

CHICKEN-WATER. 

Take half a tender chicken, strip oft' all the fat, 
break the bones ; add two quarts of water, boil half 
an hour, and season with salt. The liquor only to 
be used. 

BEEF TEA. 

Cut one pound of lean beef into small pieces, and 
boil it for twenty minutes in one quart of water, 
taking off all the scum that rises. Cool, skim, and 



196 MEASURES OF PREVENTION. 

boil twenty minutes longer; strain, and season with 
a little salt. Very nourishing:. 

MUTTON BROTH. 

Take three chops; cut off the fat; best with a 
hammer or rolling-pin; cut into small pieces; put 
into a sauee-pan with a pint of water, a little salt, 
and some crusts of bread ; cover the sauce-pan ; 
boil fast : skim for half an hour. 

TOAST WATER. 

Toast slices of bread (do not burn); put them 
into a pitcher while hot, and add boiling water. 
When cool, strain and bottle. May be warmed and 
sweetened for use. 

The above will afford ample nourishment for the 
sick and convalescent. During the first two or three 
days the patient should be restricted to the farina- 
ceous preparations. After that, chicken, mutton, and 
other animal nourishment may be used. Several 
days should elapse before solid food should be re- 
sorted to, and then sparingly at first. 



PUBLIC MEAffS OP PRETLTTTIOK. 

"The conditions of health and exemption, are 
To be cleanly in all things, and breathe pure air."' 

In reference to this subject, the first thing to be 
considered is the fact that cholera is dependent pri- 
marily on atmospheric conditions, and proximately 
on local conditions; filth, and impure air engendered 
thereby, being the most conspicuous. 



PUBLIC MEANS OF PRETENTION. 137 

The deleteriooa principle, whatever it may be, m; 
teriously generated in the great crucible of nature 
— whether coming from the jungles of India, the 
simoons of Arabia, or the craters of Vesuvius — 
may irried on the wings of the wind over the 

surface of the earth, without producing more than 
a slight disturbance of the functions of animal life, 
manifested in an unusual tendency to diseases of 
the bowels and general depression of the vital pow- 
ers. We feel the influence of this slight poison, 
but, with a little extra care in our habits of living, 
are enabled to throw it oft". It amounts only to a 
slight li predisposition." Another poisonous princi- 
ple is generated in the laboratory of terrestrial filth. 
Every city and town sends up its deleterious gases, 
its disease-ladened malaria. It combines with the 
poisonous principle with which the atmosphere is 
already impregnated, a chemical combination takes 
place between them, and a new compound is in- 
stantly generated. This is the fatal cholera poison. 
<; Predisposition'' and u susceptibility " now become 
the positive malignant disease, spreading terror and 
death in every direction. 

The cholera can not prevail without the combined 
action of these two agents. The first is beyond 
human control. It advances and recedes in obedience 
to laws of which we have no knowledge. It crosses 
oceans and continents as freely as the winds of 
heaven, and it would be as reasonable to attempt to 
control the storm and whirlwind as to attempt to 
control this cause of cholera. Its chemical afiiuity, 
however — the poisonous vapors continually arising 



138 MEASURES OF PREVENTION. 

from the cauldrons of decomposing animal and veg- 
etable matter which abound in and about the hab- 
itations of men, and without which either agent 
would be comparatively powerless for harm — is, to a 
very great extent, within our control. 

All sanitary measures should be directed to the 
thorough purification of these choleraic gas-gene- 
rating receptacles (retorts). All around us these 
manufactories of pestilential vapors are in full bla^t. 
From the stacks of offal in vacant lots ; from the 
alleys reeking with pollution ; from the gutters and 
back-yards, the tenement-houses of the poor — even 
where the proud mansions of the rich rise in costly 
grandeur — the polluting odors arise. Few persons 
realize the fact that in any great city, almost side 
by side with the lofty palaces of the rich, are to 
be found wretched hovels, squalid poverty, preg- 
nant with the germs of pestilence; and yet such is 
the case. A careful inspection would reveal the 
materials of death-dealing malaria where least ex- 
pected. This is where sanitary labor should begin. 
Competent authorities in every community, great or 
small, should be authorized to do this work. 

As an evidence of the advantages to be derived, 
one or two facts may be stated. During the visita- 
tion of the cholera in 1850, the authorities of the 
city of Boston appropriated a sum of money suffi- 
cient to cleanse and purify the streets, alleys, yards — 
every place where there was a possibility of foul 
air existing. The work was done thoroughly and 
effectively. In St. Louis no attempt was made to 
remove the filth, or in any manner to improve the 



TUBLIC MEANS OF PREVENTION. 130 

sanitary condition of the city, except what may 
have heen done by a few individuals on their own 
premises. Now compare the results. Boston, out 
of a population of 140,000, lost but 327 by cholera — 
from all causes, about 5,000; while in St. Louis, 
with less than 65,000 inhabitants, over 6,000 per- 
sons died of cholera alone. 

In 1832, the City Council of Baltimore, with 
commendable forethought and liberality, appropri- 
ated forty thousand dollars for the work of purifica- 
tion, in anticipation of the coming scourge. The 
result was, that out of a population of 160,000 but 
853 died of cholera. 

It would be useless, in a work like this, to in- 
struct or lay down any rules for the government of 
"Health Committees" or "Commissioners." These 
bodies are generally presided over by medical gen- 
tlemen in every way qualified to suggest such meas- 
ures as circumstances may call for. Every citizen, 
however, should cheerfully lend his aid in the work 
of cleanliness. Persons having in charge that duty 
should visit regularly, and at short intervals, every 
street, lane, alley, and passage-way, public or pri- 
vate, and see that no dirt or waste matter accumu- 
lates. Filth, of whatever description, should be 
immediately removed. Damp, dark rooms, cellars, 
and other places, should be whitewashed. All 
vacant lots, back-yards, and manufactories in the 
neighborhood should be visited and cleansed. Gut- 
ters and drains should be kept clear and in order. 
2so water should be allowed to stand, to become 
stagnant. Every privy and vault in the city should 
13 



140 MEASURES FOR PREVENTION'. 

be examined, emptied, if necessary, and disinfecting 
agents freely used; and in all cases where putrid or 
decaying matter has been removed, the spot should 
be covered with lime or other disinfectants. 

Whatever filth is removed should in no case be 
deposited on the surface of the ground, even though 
at considerable distance from the city. 

The over crowding of tenement-houses should be 
prohibited. Landlords should be made answerable 
for this evil. 

One of the most important duties devolving upon 
a " Board of Health" I believe to be attention to 
the state of privy vaults, the removal and dispose 
tion of their contents, as also the closest scrutiny in 
regard to any human excretions that may be depos- 
ited in yards, alleys, and out-of-the-way places. 

Circumstances led me, early in my experience, to 
give this subject especial attention. Localities where 
the disease appeared with peculiar malignance, I 
found were contaminated with the foul effluvia aris- 
ing from filthy habits. The excrement of the sick, 
if not immediately removed, I am convinced, is a 
greatly aggravating cause of fatality. 

In confirmation of this opinion, Dr. Jameson men- 
tions several facts. He says: "We were once cog- 
nizant of dysentery being occasioned by exposure to 
human filth. A privy, which had served the pur- 
pose of a pretty extensive hotel, in an inland town, 
without being cleaned out for several years, was 
emptied in the summer season. A most terrible 
stench was produced in one of the streets, by scat- 
tering a good deal of the contents of the privy ; in a 



PUBLIC MEANS OF PREVENTION. 141 

iew days several families were affected with severe 
[ysentery, while no eases occurred in any of the 
ither streets. During the American war, an Amer- 
ican regiment, consisting of six hundred men were 
ffected with dysentery, from heing encamped near 

large mass of human feces, and the disease soon 
ras checked hy removing their camp at a distance 
rom it." 

It is not necessary to speculate or discuss the 
irobabilities of the truth or falsity of the opinion 

have advanced. The facts are certainly sufficient 
o attract our attention when the great danger is 
igh. In ordinary epidemics, cleanliness in all 
bings is requisite to exemption; but in cholera the 
ecessity for strict sanitary precaution is tenfold 
■rearer, since it is easier to prevent than it is to cure 
he disease. 



PART IX. 

OO^OO 

THE BROAD STREET PUMP. 

AN EPISODE IN THE CHOLERA EPIDEMIC IN LONDON. 



BY THE REV. H. WHITEHEAD. 



Early on the morning of September 1, 1854, in 
the Berwick Street district of St. James's, "West- 
minster, where I had spent some hours of the pre- 
ceding day without hearing any mention of cholera, 
and where, in former epidemics, the mortality from 
that disease had been inconsiderable, I was asked 
to visit a house in which lay already collapsed four 
persons who had been seized with cholera during 
the night; and, on leaving this house, whicheVer 
■way I turned, I came upon similar scenes. At noon, 
when I met my brother curate and the Scripture 
-reader, for a short time, in the vestry of St. Luke's, 
Berwick Street, I learned that they had each been 
occupied all the morning in the same way as myself. 
The rest of the day was spent in the same manner ; 
and, as an indication of the severity of the outbreak, 
I record that of all the cholera patients visited by 
me on that day only one recovered. 

This state of things apparently continued for four 

(142) 



AX EPISODE OF THE CHOLERA IX LONDON. 1 1 ; » 

(lavs, during which time the medical men of the 
neighborhood, whose Labors, day and night, w behalf 

of the sufferers were beyond all praise, declared, with 
one consent, that specific remedies were unavailing; 
and as for " premonitory symptoms," there were, 
they said, few, or even in some cases none at all. 

On the fifth day we were all agreed that a change 
for the better had taken place, as we perceived that 
fewer persons were attacked than at first, and that 
the attacks were less severe. This change, however, 
was subsequently seen, when the statistics of the 
outbreak were collected and examined, to have been 
more gradual, and to have begun at an earlier 
period, than we had supposed ; for, though the 
deaths were as numerous on the 3d and 4th of Sep- 
tember as on the 1st, yet the greatest number of 
fatal attacks occurred on the 1st, after which there 
were fewer fatal attacks on each succeeding day, 
the number positively decreasing 50 per cent, on the 
3d as compared with the 2d, and 10 per cent, on the 
2d as compared with the 1st. Perhaps the most 
fatal period of attack was the hour or two before 
midnight on August 31. The deaths were the most 
numerous on September 2, the excess of mortality 
on that day being due to attacks on the previous 
day. By the 10th, the number of fatal attacks 
throughout the whole parish of St. James had de- 
clined the low average of the preceding month. 

But during those ten days the ravages of the dis- 
ease, in a small and remarkably well-defined part of 
the parish, were very severe, nearly seven hundred 
persons having been fatally seized, in that short 



144 THE BROAD STREET PUMP. 

time, within a circuit of two hundred and fifty yards 
radius from the point of junction between Broad 
Street and Cambridge Street. Such was the in- 
tensity of the outbreak that of forty-five contiguous 
houses, extending in different directions from that 
point, only four escaped without a death ; and at an 
average distance of fifteen yards from St. Luke's 
church, situated within the compass of said radius, 
were four houses which collectively lost thirty-three 
inhabitants. Of the streets thus devastated, Broad 
Street itself suffered the most severely, its popula- 
tion having been just decimated, ninety of its eight 
hundred and ninety-six inhabitants having died, 
beside twenty-eight non-resident work-people. Other 
streets, however, had nearly as high a rate of mortality. 

Thus limited in its extent, brief in its duration, 
and continually on the wane from the very first mo- 
ment of its appearance was this great outbreak, 
the like of which had, perhaps, never before been 
seen in this country. 

Of course, as- soon as it began to subside, leaving 
us time for reflection and discussion, we indulged 
in speculation respecting its origin; but none of us 
could advance a satisfactory hypothesis, for the 
simple reason that its facts seemed to contradict all 
the then prevalent theories concerning the spread 
of cholera. 

The district itself resembles surrounding districts 
which escaped, while it might be favorably contrasted 
in sanitary matters with other parts of London 
which were lightly visited. Its level, too, is com- 



AN EPISODE OF THE CHOLERA IN LONDON. 145 

paratively high, in which respect it presents an ex- 
ception to a supposed law which had previously 
seemed to operate in connecting cholera more es- 
pecially with the lower levels of London. 

All this may, at first sight, appear very unsatis- 
factory, and so it appeared at the time to such of 
us as cared to speculate as to the origin of the out- 
break. Nevertheless we were not without hope that 
its remarkable character would render its determin- 
ing cause somewhat easy of detection. We had 
observed that its limits in every direction were most 
sharply defined, that those limits lay within a narrow 
compass, and that the beginning of the outbreak 
was very clearly marked in point of time. There 
had been scattered cases of cholera throughout the 
parish before September; but it was evident that 
something new and distinct suddenly came into 
operation on the last night in August. What that 
was we trusted might eventually be ascertained. 

It was, therefore, with great satisfaction that we 
heard that, on the motion of Dr. Lankester, a com- 
mittee had been appointed by the Vestry of St. 
James to inquire into all the circumstances of the 
case. 

The Cholera Inquiry Committee was composed of 
eight vestrymen, six medical men, and one other 
clergyman beside myself; and, after long and labor- 
ious examination of every circumstance which could 
possibly throw light on the subject of our inquiry, 
a report, drawn up by Mr. J. Marshall, then assist- 
ant surgeon and now surgeon of University Hospital, 
was presented to the vestry, which report, if it could 



146 THE BROAD STREET PUMP. 

have been widely circulated, would have rendered 
it wholly unnecessary for me to write another line 
upon the matter to which it relates. 

In this investigation, while we did not overlook 
such general conditions as might have operated in 
producing a widely-spread epidemic, we yet felt that 
they must have required some special or local con- 
ditions to intensify its influence within the small 
compass which demanded our more immediate at- 
tention. Every local condition, therefore, of the 
infected district, such as elevation of site, nature of 
soil and subsoil, surface and ground plan, streets and 
courts, density and character of population, internal 
economy of houses, cess-pools, house-drains, and 
sewerage, was minutely investigated. But, though 
we found much to lament or condemn in most of 
these particulars, we could not find in them any sat- 
isfactory explanation of the sharp line of demarka- 
tion which on every side surrounded what we termed 
the " cholera area" in the midst of a densely-peopled 
neighborhood ; nor could we derive from them any 
theory which accounted for the apparent anomalies 
within the area itself. 

It was, however, in these very anomalies that we 
found the clue which ultimately led us to a unani- 
mous conclusion " that the sudden, severe, and con- 
centrated outbreak, beginning on August 31 and 
lasting for the few first days of September, was in 
some manner attributable to the use of the impure 
water of the well in Broad Street." 

One member of the committee, the late Dr. Snow, 
even before the committee was formed, had pro- 



AN EPISODE OF THE CHOLERA IN LONDON. 147 

pounded this opinion, and, indeed, had prevailed 
upon the parish authorities to remove the handle of 
the pump on the 8th of September. But scarcely 
any one seriously believed in his theory. For my 
own part, when I first heard of it, I stated to a 
medical friend my belief that a careful investigation 
would refute it, alleging as one proof of its inac- 
curacy the fact of several recoveries from collapse 
having taken place, at least in spite of, if not act- 
ually by reason of, the constant use of the Broad 
Street water. 

I added that I knew the inhabitants of Broad 
Street so well, and had occasion almost daily to 
spend so much time among them, that I should have 
no great difficulty in making the necessary inquiries. 
Accordingly I began an inquiry which ultimately 
became very elaborate, at an early stage of which, 
however, one day meeting the same friend, and 
being asked by him what way I had made toward 
clearing the character of the pump, I wa3 obliged 
to confess that my opinion on that matter was less 
confident than when we had last talked about it. 
Soon after making this confession, I received from 
Dr. Snow a copy of the second edition of his work 
on "The Mode of Communication of Cholera/' in 
which I found an account of his researches into the 
supposed influence of the Broad Street well in pro- 
ducing the St. James' outbreak. I found, moreover, 
that he attributed this influence not to general im- 
purity in the water, but to special contamination of 
it from the evacuations of cholera patients, which 
he conjectured must have reached the well from the 



148 THE BROAD STREET PUMP. 

sewer or eess-pool. In thanking him for the book, 
while I could not help admitting the weight of 
many of his recorded facts, I still clung, as a last 
resource, to an a priori objection to his theory, urg- 
ing that if special contamination of the water in 
the way suggested had begun the mischief, the out- 
break ought not so soon to have subsided, when- 
much larger quantities of cholera excretions must 
have been continually pouring into the well through 
the same channel, whatever it might have been, of 
communication with the sewers. As for cess-pools, 
I at that time supposed they had mostly been abol- 
ished. 

In the face, however, of these objections, the evi- 
dence implicating the pump kept on accumulating, 
not only in my hands, but also in those of other 
members of the committee who were engaged in a 
similar inquiry, until, at length, sufficient evidence 
was collected to bring the whole committee to the 
unanimous verdict which they finally recorded. 

I can not, in the space now at my disposal, set 
forth this evidence in detail ; but I will touch on its 
most salient points. 

It appeared, then, according to a carefully executed 
plan of the district, in which every house and every 
death was indicated, that the Broad Street public 
pump occupied a strikingly central position in the 
"cholera area;" that there was no other public 
pump within the area; and that, except in one di- 
rection, the mortality diminished almost to total 
disappearance on approaching decidedly nearer to any 
other pump. The exception w^as the neighborhood 



AN EPISODE OF THE CHOLERA IN LONDON. 14'.> 

of the pump in Little Marlborough Street, in which 
neighborhood several deaths took place in Cross 
Street and Carnaby Street. But, as a matter of 
fact, the inhabitants of those streets did resort to 
the Broad Street pump, having, whether with or 
without reason, conceived a dislike to their own 
pump. A friend of mine, having more than once 
urged Cross Street as an obvious objection to the 
water hypothesis, went and made some inquiries in 
that street. When I next saw him he begged to 
withdraw his objection. Dr. Snow examined the 
cases of forty-eight persons who had died in houses 
nearer to other pumps than to that in Broad Street, 
and discovered that twenty-eight had actually from 
preference drank the Broad Street water shortly 
before being attacked, while there was a probability 
that ten of the others also drank it. The details 
of this examination are given in the report. 

Broad Street itself, as I have already said 5 suffered 
the most severely of all the streets. Ninety of its 
eight hundred and ninety-six inhabitants died, be- 
side twenty-eight non-resident work-people. Of 
those twenty-eight work-people, seven belonged to 
a factory where the pump water was habitually 
used, while an adjoining factory, employing the 
same number of persons, w T here this water was never 
used, lost not a single " hand ; " eighteen others of 
the twenty-eight worked at a factory situated close 
to the pump, from which water was daily fetched for 
the use of the workers; and these eighteen w T ere all 
fatally seized during the first two days of the out- 
break, after which the factory was temporarily closed. 



150 THE BROAD STREET PUMP. 

On the other hand, not a single death occurred 
among the seventy men employed at a brewery on 
the same side of the street, of whom it was affirmed 
to be certain that none ever used the pump water, 
there being a deep well on the premises. With one 
exception, and that a house with only three inmates, 
the brewery (with its seventy men) was the only 
house free from death among the twenty-two houses 
(with their sixty-seven deaths) on the south-side of 
the street. An additional contrast to this remark- 
able exception was presented by the mortality among 
the laborers at work on an unfinished model lodg- 
ing-house at the rear of the brewery, and separated 
from it only by a narrow court, seven out of thirty- 
five men so employed having been fatally seized 
with cholera. The works were stopped on the third 
day of the outbreak, and it was ascertained that the 
Broad Street water had been in use among these 
men. 

One-half of Golden Square is within the limits of 
the cholera area, and yet entirely escaped. It is 
considerably nearer to two other pumps. On the 
other hand, St. Anne's Court, which lies just be- 
yond the radius, and was heavily visited, is almost, 
throughout its whole length, nearer to the Broad 
Street pump than to any other. 

St. James's AVork-house, not 150 yards from the 
center of the area, surrounded on all sides by houses 
in which the deaths were numerous, and subject to 
the continual importation of the dying and the dead, 
lost only 5 of its 500 regular inmates ; exactly the 



AN EPISODE OF THE CHOLERA IN LONDON. 161 

same number as in former visitations. The pomp 
water was never used there. 

Peter Street afforded, perhaps, as singular an in- 
stance as could be found of what is often termed 
the capriciousness or eccentricity of the cholera; 
for, whereas there were 19 deaths in its smaller 
(western) portion, there was only 1 death in its 
much larger (eastern) portion. Now, the halting- 
place of the pestilence — a house which lost 12 of its 
inhabitants — is only a few yards beyond the line of 
equidistance between the Broad Street and Rupert 
Street pumps, and the use of the Broad Street water 
in that house was ascertained to a certainty. The 
further one goes eastward from this house, of course, 
the uncertainty as to the relative distances from the 
two pumps becomes less. But the one victim fur- 
ther east " fetched in a large can of water from 
Broad Street, on the 2d of September, and began 
drinking it freely." 

One fact is remarkable. A lady, residing at 
Hampstead (West End), being very partial to the 
Broad Street water, was in the habit of drinking it 
daily, having it fetched in a bottle by a cart that 
went every day from Broad Street to Hampstead. 
She was seized with cholera on September 1, and 
died the next day. A lady staying with her at the 
time also drank of it and died. A servant drank 
the water, and had a slight attack of diarrhea. 
No other case of cholera occurred at West End. 

Dr. Snow ascertained that 61 out of 73 persons, 
registered as having died in the immediate neigh- 
borhood of the Broad Street pump ou the first two 



152 THE BROAD STREET PUMP. 

days of September, had been accustomed to drink 
the pump water either constantly or occasionally; 
while in 6 cases only was he informed that the de- 
ceased used not to drink this water, and concerning 
the remaining 6 he could learn nothing. The keeper 
of a coffee-shop frequented by mechanics, where 
this water was supplied at dinner-time, told him, on 
the 6th of September, that she was already aware 
of nine of her customers who were dead. He also 
recorded the case of a gentleman who came from 
Brighton, on the 1st of September, to see his brother, 
who had been seized with cholera. He found his 
brother dead, did not see the body, and, having 
taken some luncheon, with a small tumbler of 
brandy and water — the water being from Broad 
Street — left the house in twenty minutes. He died 
of cholera next day at Pentonville. In one street, 
assigned to Dr. Snow by the committee for special 
investigation, he found that, of its fourteen houses, 
the only four which escaped without a death were 
those in which the Broad Street water was never 
used, whereas it had been more or less used in the 
other ten. 

What, after all, was the matter with the well? 

One of the strangest facts in connection with this 
inquiry is, that the impurity of the well-water was, 
in point of time, the very last discovery made by 
the investigators. We collected the evidence already 
described, not only in ignorance of the fact of the 
well having been contaminated, but in the face of 
positive and seemingly reliable evidence to the con- 
trary. The sides of the well had been examined, 



AN EPISODE OP THE CHOLERA IN LONDON. 158 

and declared — in a report made, by order of the 
Paving Board, on November 27, 1854 — "free from 
fissures or other communications with drains or 
sewers, by whieh such matters could possibly be 
conveyed into the waters." Both chemical and 
microscopical analysis had "failed to detect any 
thing which could be pronounced peculiar to a chol- 
era period, or capable of acting as a predisposing, 
co-operating, or specific agent in the production of 
that disease." 

"We stand exonerated, therefore, from the impu- 
tation of seeking to impugn the well-water as ac- 
countable for the outbreak on the ground of any 
previous knowledge of its impurity. Indeed, for my 
part, as I have sufficiently shown, I had a leaning 
the other way. And well I might have such a 
leaning, having myself drank a little of the water, 
cold, with brandy, on the evening of September 3. 
On that day, we now see, it was less injurious than 
it had been ; otherwise, as I found from other cases, 
brandy would not have neutralized the effects of the 
water when taken cold, though, of course, it dimin- 
ished the quantity. In spite of my original bias, 
however, I went on collecting the evidence, until, 
at the very close of my inquiries, I accidentally 
lighted on a fact which led to further examination 
of the well, and to the excavation of the soil be- 
tween the well and the nearest house. 

From this examination there resulted the fol- 
lowing disclosure. Old-fashioned, flat-bottomed, its 
mortar-joints perishing, its brick-work decayed, the 
main drain from the house entered the sewer at the 



154 THE BPwOAD STREET PUMP. 

top instead of at the bottom, thereby dispensing 
with the usual fall, and facilitating the premature 
exit of fluid through its sieve-like sides. Congenial 
appendage to such a drain, a cess-pool intended for 
a trap, but misconducted, was discovered in the 
front area, with other abominations, unmolested 
by water, which I forbear to recite. The cess-pool, 
of course, rivaled the drain in the disreputable 
state of its brick-work, the bricks admitting of be- 
ing lifted from their beds without using the least 
force. The continuous passage of the fluid through 
the sides of the cess-pool being thus provided for, 
similar arrangements for its overflow presented 
themselves to the notice of the investigators, in the 
shape of a covering of saturated rotten boards. In 
close proximity both to drain and cess- pool — its 
water line but eight feet of vertical depth below the 
bottom level of the cess-pool — two feet eight inches 
the horizontal distance between the outer brick-work 
and the drain — stood the Broad Street well. I need 
scarcely dilate upon the " washed appearance of 
ground and gravel — channeled furrows observable 
from the inside the well; black, saturated, swampy 
soil " — in order to prove that the same policy which 
had long used the Thames for a sewer, had, at least 
in one case, made a cess-pool of a well. 

If I have said any thing in this paper -which ap- 
pears to militate against the views of those who 
connect filth with cholera, I trust that I have now 
made amends, having furnished them with an addi- 
tional argument for urging the disuse of the London 
surface wells, which, from their very nature, are, 



AN EPISODE OF THE CHOLERA IX LONDON. 156 

as our report alleged, M not only liable to special 

-animation, but Bubject to constant, anavoidal 
and habitual impurity." And yet, strati::'' * 
they are held in great repute. It is a fact that the 
Broad Street pump could boast a metropolitan re 
lation. It has been said. I know not with what 
truth, that its water was selected to sparkle in a once 
brated "nectar." Its reputation is explained by 
Mr. Marshall as having been "partly due to its low 
temperature, to the quantity of carbonic acid con- 
tained in it. and to the saline matter preventing its 
decomposition until after it had free access to the 
air." 

It only remains that I should relate the circum- 
stance which led to further examination of the well, 
and the excavation of the surrounding soil. 

There were, as I have stated, three cases of 
:-holerain Broad Street before the 31st of August, on 
the evening of which day the srreat outbreak besran. 
[n consequence of Dr. Snow's suggestions, I made 
particular inquiries respecting the two persons seized 
:»n August 12 and 30. But both these cases had 
been in houses too far removed from the well to 
affect it otherwise than through the sewer, which, 
beinof a new sewer, seemed verv unlikelv to leak. 
As to the lirst cases, on August 31, they were - 
nearly simultaneous as to preclude the notion of 
their having been otherwise connected with each 
other than as having a common origin. But. sin^u- 
[arly enough, I at lirst overlooked the case of August 
2S. or, rather, I had recorded only the date of 
death, September 2. I can only account for mv 
14 



156 THE BROAD STREET PUMP. 

not having inquired particularly into this case by the 
fact of its having been that of an infant, and I had 
not supposed that any one who died in Broad Street 
on the 2d of September had been ill for several 
days. One day, however, while searching a file of 
the Registrar's returns for another purpose, I came 
on the following entry: 

"At 40 Broad Street, 2d September, a daughter, 
aged five months; exhaustion, after an attack of 
diarrhea, four days previous to death." 

From my familiarity with the street, I knew that 
this was the house immediately facing the pump ; 
so I hastened ofT at once to the house, and ascer- 
tained from the mother, who occupied the back 
parlor, that the child was attacked on August 28, 
and that the dejections at first were abundant, but 
ceased on the 30th. In answer to further questions, 
she told me that the dejections were collected in 
napkins,, which, on being removed, were immediately 
steeped in pails, the water from which was poured 
partly into a sink in the back yard and partly into 
a cess-pool in the front area. 

Being struck with the dangerous proximity of 
this cess-pool to the pump-well, I communicated the 
facts to the committee, who forthwith ordered an 
investigation to be made, with what result has 
already been described. 

Now, if this child's dejections did the mischief, 
it is easy to see, as they ceased on August 30, how 
so shallow a well may have purified itself in a few 
days, especially as the cholera patients drank its 



AN EPISODE OF THE CHOLERA IN LONDON. 157 

water copiously, some of them at the rate of four 
gallons a day. 

Bat it is not easy to see why the mischief was 
not prolonged by further contamination of this 
water from subsequent cases in the same house. 
Certainly it may be suggested that the well may 
have killed off most of its habitual drinkers in the 
first few days of the outbreak, leaving only non- 
drinkers and those who were proof against its in- 
fluence. But that is not a satisfactory hypothesis. 
A better explanation, perhaps, may be found in the 
act of three of the subsequent cases having occurred 
in the upper back rooms, where there was a great 
temptation, in the confusion of the moment, to 
throw the evacuations out of the windows into the 
vard, which I ascertained was in one case actuallv 
done. And the fifth and last case in this house, 
which was that of the father of the infant, occurred 
on September 8, the very day on which the handle 
of the pump was removed. 

Of course there arose considerable discussion among 
the doctors as to the precise nature of the child's 
illness, some contending that its diarrhea was not 
choleraic — an opinion which is entitled to the more 
respect from its having been that of the doctor who 
attended the child. The committee, therefore, did 
not pledge themselves to the conclusion that the 
outbreak was due to this case. 

But this much, at any rate, may be affirmed, that, 
whatever uncertainty there may be about the nature 
of the infantine diarrhea, the plain fact of the child's 
dejections having been poured into a cess-pool (the 



158 THE BROAD STREET PUMP. 

connection between which and the pump-well is 
clearly established) for the period of three days im- 
mediately preceding a great outbreak, the phenomena 
of which point decidedly to the pump as its origin, 
is indeed a very remarkable coincidence. 



PART X. . 



-»o>a<oo- 



CONCLUDING REMARKS. 



In a preceding chapter, the imperative necessity 
for cleanliness and care in regard to the removal 
and disposition of fecal matter — especially the excre- 
ments of cholera patients — was alluded to. The 
history of the " Broad Street Pump " affords an 
illustration of the importance of this subject. The 
recent outbreak of cholera at Epping, near South- 
ampton, England, gives additional confirmation to 
the urgency of the suggestions made. The disease 
suddenly invaded Epping during the latter part of 
January of the present year. A knowledge of the 
presence of the epidemic at Southampton had cut 
off communication between the two places. The 
choleraic atmosphere, however, existing at the latter 
place, no doubt was carried by the winds over the 
suburban town, subjecting the inhabitants to its in- 
fluence, as was evidenced by an unusual number of 
cases of diarrhea, and the general prevalence of 
bowel complaints. The irruption of cholera, though 
circumscribed in its limits, as in the case of the 
"Broad Street" outbreak, was most fatal in its re- 
sults. 

(159) 



160 CONCLUDING REMARKS. 

The authorities directed an inquiry to be made 
into the origin of the disease in that locality, and it 
was ascertained that a house-well, the water of 
which was used by the family in which the disease 
made its first appearance was polluted by the drain 
from a privy and sink. It is not necessary that the 
water so contaminated should be taken into the 
stomach to produce disease. The subtle poison, 
more extensively diffused by admixture with the 
fluid, is thrown off with its moisture and vapors, 
which, being inhaled, produces its baleful effects. 
This result is riore particularly observable in cases 
where women have washed the soiled clothing of 
those who w»ve or had been sick of the cholera. In 
consequence of the steam coming in contact with 
the lungs t 1 ; ij have been taken down with the dis- 
ease. 

All vessels used by cholera patients should be 
thorougl 'y and repeatedly cleansed, using for this 
purpose a small quantity of the solution of chloride 
of lime The apartmojt should be well disinfected, 
by the v.eans heretofv/o suggested, and the vault or 
receptacle for the excrements should be most carefully 
attended to, and froo use made of disinfecting agents. 

A table- spoonful of the solution of chloride of 
lime, or soda, &died to a gallon of water in which 
soiled linen or cotton garments are to be washed, will 
counteract the poison. This solution, however, de- 
stroys the fukric of woolen goods, and to cleanse 
these a ama 7 ! quantity of benzine or coal-oil may 
first be ,/s^J, and afterward soap and water. 

In co fading this treatise, I would take occasion, 



THE CHOLERA MEDICINE CASE. 161 

once again, to urge the necessity for the adoption of 
strict sanitary measures during the expected ap- 
proach and continuance of the cholera, as also the 
importance of unremitting watchfulness and prompt- 
itude in the treatment of the "premonitory symp- 
toms." 

Recovery, or death, in the "collapsed" disease, 
depends upon the vital energies of the patient, and 
the strength of the poisonous influence. Medical 
treatment is only valuable when life is struggling, 
hand in hand with strong vital powers, against the 
encroachments of death. The functions may be as- 
sisted in turning the scale in favor of recovery; but, 
more frequently, the failing powers are too much 
prostrated to rally, and all remedies will prove una- 
vailing in arresting the fatal progress of the disease. 



THE CHOLERA MEDICINE CASE. 



Every individual and every family should have 
the necessary medicines within reach during the 
prevalence of cholera. In the mode of treatment I 
have suggested, the remedies designated are the 
most reliable and available that can be recommended 
for general and indiscriminate use. Under the im- 
mediate care of an experienced physician, many 
modifications of the treatment, suggested by the 
attendant circumstances, might be made with ad- 
vantage. 



162 THE CHOLERA MEDICINE CASE. 

For the accommodation of individuals, families, 
etc., I am prepared to furnish packages containing all 
the articles required for the successful treatment of 
cholera. The medicines will be of the best quality, 
carefully compounded, divided into appropriate doses, 
where practicable, and neatly, conveniently, and sub- 
stantially put up. 

The package will contain several very important 
remedies not alluded to in the treatment I have laid 
down for general use, for the reason that they can 
seldom be obtained, and any directions for preparing 
them would only tend to confuse and complicate the 
treatment. 

Aside from the incalculable value of these medi- 
cines during the prevalence of cholera, the case 
contains the best remedies known for diarrhea, 
dysentery, flux, cholera-morbus, hemorrhage of the 
bowels, and summer complaints generally. 

Plain and full directions for the use of the medi- 
cines will be sent. 

The cholera medicine case will be of three differ- 
ent sizes, adapted to the probable wants of individ- 
uals, families, etc. : 

No. 1, for a single individual $3. 

No. 2, for a small family So. 

No. 3, containing double the quantity of No. 2 S8. 

Orders, inclosing the money, will be promptly 
attended to, and the case sent by mail or express, as 
desired. 

Address Dr. G. T. Collins, care of J. R. Hawley 
& Co., Publishers and Stationers, No. 164 Vine street, 
Cincinnati, Ohio. 

•^77 * 



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